| dc.description.abstract | Introduction
Urinary tract infections (UTIs) are an important cause of childhood morbidity. There has been growing concern over the global increase in microbial resistance to most commonly used antimicrobials. Although UIIs are some of the commonest HAls, little has been done on susceptibility patterns of bacterial
pathogens causing UTIs in Kenya. It is therefore of importance to get the local pattern of antimicrobial susceptibility in order to support an empirical approach to the management of these infections, as well as for policy making.
Objective
To determine the antimicrobial susceptibility patterns of urinary tract pathogens isolated in the paediatric age group at The Nairobi Hospital.
Study design
A retrospective cross-sectional descriptive study.
Study setting
The Nairobi Hospital records department.
Study population.
Children below the age of 12 years diagnosed with urinary tract infections by conventional culture methods in the period July 2009 to June 2011.
Methodology
Positive urine culture reports for the period July 2009 to June 2011 were analyzed with respect to the organisms isolated and their antimicrobial susceptibilities.
This involved data abstraction from clinical laboratory records and case files of a number of paediatric patients diagnosed to have UTIs by conventional laboratory urine culture methods in the sI?ecified 2 year period. Data specifically on the pathogens isolated and their susceptibilities to the various antimicrobial agents were abstracted and analyzed. There was further stratification into three age groups 0-11 Months,1 to 6 years and 7 to 12 years), and classification based on hospitalization status.
Results
Commonly isolated bacterial agents were Escherichia coli (n=132; 44.3%), Klebsiella (n=59; 17.8%), Proteus species (n=28; 9.4%), Staphylococcus aureus (n=14; 5.7%), Pseudomonas species (n=14; 4.7%) and Enterococcus species (n=12; 4%).Others were less frequently isolated making up a total of 14.1 %. The difference in the organisms isolated in the different age groups was not statistically significant (p=0.08). Girls were more affected than boys with a ratio 6:4.
Amongst the E.coli and Klebsilla isolates tested, most were resistant to ampicillin, trimethoprimlsulfamethoxazole and piperacillin, half were susceptible to amoxicillin clavulanate. Susceptibility to other tested antimicrobials was high, including nitrofurantoin, cephalosporins, gentamycin, amikacin, meropenem and tobramycin. There was no statistical significance in the difference in the organisms isolated between the inpatient and outpatient (p= 0.775). There was no difference between the susceptibilities of organisms isolated from the inpatient and outpatient cases to all tested antimicrobials.
Conclusion
E. coli is the most common cause of uncomplicated UTI at the Nairobi hospital, followed by klebsiella spp, proteus spp and staphylococcus spp. There is no association between hospitalization status and organisms isolated as well as their susceptibility patterns in the case of uncomplicated UTIs. In conclusion the choice of drugs used in the treatment of UTIs today is quite narrow due to the wide scale resistance that the common UTI pathogens show to drugs which have been used previously.
Recommendation
Revision of the current guidelines, prudent use of antibiotics and regular surveillance of uropathogens and antimicrobial susceptibility patterns on a larger scale is recommended. | en_US |
