Document Type : original article
Authors
Department of Pediatrics, School of Medicine, Islamic Azad University, Kazerun, Iran.
Abstract
Background: The increasing prevalence of antimicrobial resistance has emerged as a critical global public health issue. This study aimed to identify the predominant bacterial pathogens causing community-acquired urinary tract infections (UTIs) in children and to evaluate the evolving patterns of antimicrobial resistance among pediatric uropathogens in Shiraz, southern Iran.
Methods: This research involved two prospective cross-sectional studies conducted among pediatric patients diagnosed with UTIs. The first study was carried out from 2005 to 2006 and included 435 children, while the second study, conducted from April 2010 to March 2011, enrolled175 children. Participants were children aged 1 month to 10 years suspected of having UTIs and referred to various outpatient pediatric clinics. Informed consent was obtained, and demographic data and laboratory test results were recorded using a standardized checklist. Urine samples were collected via urine bags for children under 2 years old and midstream clean-catch for older children. Patients were included if they presented with pyuria (white blood cell count >10 cells/µL) and UTI symptoms, such as dysuria, frequency, fever, etc. Bacterial culture was performed on blood agar and eosin methylene blue (EMB) agar, followed by antimicrobial susceptibility testing on isolated pathogens. Data were analyzed using SPSS version 19. Statistical analysis involved Pearson correlation and Chi-square tests, with a p-value of less than 0.05 considered significant.
Results: In the initial study (2005-2006), Escherichia coli was the most common pathogen (69.2%), followed by Klebsiella (13.33%) and Enterobacter (12.18%). The male-to-female ratio was 0.417, with the highest infection rate in infants under 12 months (p = 0.002). Resistance was highest for Amoxicillin (93.83%), Ampicillin (84.39%), Co-trimoxazole (60%), and Cephalotin (58.71%), and lowest for Nitrofurantoin (12.63%) and Ciprofloxacin (7.77%). In the follow-up study (2010-2011), E. coli remained dominant (67.43%), followed by Proteus (11.43%) and Klebsiella (6.85%). The male-to-female ratio was 0.2 and infections were highest in children under 12 months (p = 0.016). Resistance increased for Co-trimoxazole (64.85%), Cefixime (53.42%), Nalidixic acid (52.98%), and Nitrofurantoin (44.77%), while moderate resistance was noted for Gentamicin (39.19%) and Ciprofloxacin (22.55). A significant association existed between bacterial type and age groups in the second study (p = 0.002).
Conclusion: An upward trend in resistance was observed for commonly used oral antibiotics such as Co-trimoxazole, Cefixime, Nalidixic acid, and Nitrofurantoin. However, resistance remained lower for parenteral agents including Gentamicin, Cefotaxime, Ceftizoxime, and Ciprofloxacin. This highlights the ongoing challenge in selecting effective empirical antibiotic therapies for pediatric UTIs.
Keywords
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