A retrospective study on the microbial spectrum and antibiogram of uropathogens in children in a secondary care hospital in Rural Vellore, South India

Retrospective Analysis of Urinary Tract Infection in the Pediatric Population at a Tertiary Care Centre

Background: Urinary tract infection (UTI) is among the most common infections occurring during childhood. It is caused by both gram-negative and gram-positive bacteria and Escherichia coli is the most common causative agent.

Methods: Data of all pediatric patients in the age group of 6 months to 18 years with urinary tract infection were taken for analysis. Urine samples were collected and cultured on the cystine lactose electrolyte-deficient medium. The presence of bacteria was identified using biochemicals, and the antimicrobial test was performed using the Kirby-Bauer test or the VITEK 2 compact system (bioMérieux, Inc., France).

Results: The prevalence of UTI was 23.5%. In total, 614 specimens tested positive with significant bacteriuria. The male-to-female ratio was 1:2.3. Approximately 54% patients presented with urinary symptoms alone. Culture positivity was significantly associated with pyuria (p < 0.0001). E. coli (334/614) was the most common isolate, followed by Enterococcus spp. (92/614). Colistin, polymyxin B, fosfomycin, nitrofurantoin, netilmicin, and amikacin were extremely good acting antimicrobials. Meanwhile, ampicillin, cefotaxime, ceftriaxone, and norfloxacin were highly resistant to gram-negative bacteria. Multidrug-resistant bacteria and extended-spectrum beta-lactamase-producing bacteria were found in 47% and 44.1% of cases, respectively. Vancomycin, linezolid, teicoplanin, and nitrofurantoin were highly effective against gram-positive bacteria. Furthermore, norfloxacin, trimethoprim/sulfamethoxazole, ciprofloxacin, and tetracycline were highly resistant to gram-positive bacteria. Of the 92, 42 Enterococcus spp. were resistant to high-dose gentamicin.

Conclusion: Nitrofurantoin and amikacin can be used as empirical therapy for gram-negative and gram-positive bacteria. Because resistance to various commonly used antibiotics is found to be increasing, treatment must be guided by antibiotic susceptibility reports.