Journal of Pediatric Perspectives

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

Study of The Antibiotic Resistance Patterns of Urinary Tract Infections in Hospitalized Children in Mazandaran

Document Type : original article

Authors

1 Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

2 Department of Microbiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

3 Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran.

4 Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

5 Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.

Abstract

Background: Identifying antibiotic resistance in uropathogenic pathogens is essential to avoid treatment errors and minimize treatment costs. Despite the clinical significance of Urinary tract infections (UTIs) in children, limited data are available on the antimicrobial resistance patterns of the causative pathogens, highlighting the need for continuous surveillance. Our aim was to determine the pattern of drug resistance in strains isolated from children with UTI.
Methods: This retrospective cross-sectional study was conducted from 2021 to 2023 at Bo Ali Sina Hospital in Sari, Iran. A total of 1502 positive urine culture samples from hospitalized children were included. Antimicrobial susceptibility testing was performed using the disk diffusion method, following Clinical and Laboratory Standards Institute (CLSI). guidelines Data analysis was carried out using Statistical Package for the Social Sciences (SPSS) software.
Results: Of the 1502 cases, 68.8% were female. The most frequently isolated pathogen was Escherichia coli (54.8%), followed by Pseudomonas aeruginosa (3.3%) and Klebsiella spp. (3.1%). Among Gram-positive bacteria, Staphylococcus epidermidis (9.0%) was the most prevalent. The highest susceptibility rates were observed for amikacin across E. coli, Klebsiella, and Pseudomonas isolates.
Conclusions: Based on local susceptibility patterns, antibiotics such as amikacin, nitrofurantoin, gentamicin, imipenem, ceftazidime, and ceftriaxone may be considered for empirical treatment of complicated UTIs in hospitalized children to improve their care. However, whenever possible, narrow-spectrum antibiotics should be prioritized. Appropriate antibiotic selection must rely on microbial identification and resistance profiling.

Keywords

References
  1. Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary tract infections: the current scenario and future prospects. Pathogens. 2023 Apr 20;12(4):623.
  2. Kumwenda P, Semu P. Characterization of urinary tract infections among females at a tertiary hospital in Malawi: a retrospective study. BMC Infectious Diseases. 2025 Apr 5;25(1):466.
  3. O'brien VP, Hannan TJ, Nielsen HV, Hultgren SJ. Drug and vaccine development for the treatment and prevention of urinary tract infections. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management. 2017 Feb 15:589-646.
  4. Leung AK, Wong AH, Leung AA, Hon KL. Urinary tract infection in children. Recent patents on inflammation & allergy drug discovery. 2019 May 1;13(1):2-18..
  5. Kolman KB. Cystitis and pyelonephritis. Prim. Care Clin. Off. Pract. 2019 Jun;46:191-202.
  6. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatrics and international child health. 2017 Oct 2;37(4):273-9.
  7. Yang SS, Tsai JD, Kanematsu A, Han CH. Asian guidelines for urinary tract infection in children. Journal of Infection and Chemotherapy. 2021 Nov 1;27(11):1543-54.
  8. Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021 Feb 1;147(2).
  9. Fatima T, Rafiq S, Iqbal A, Husnain S. Prevalence and antibiogram of MDR E. coli strains isolated from UTI patients—1-Year retrospective study at Nishtar medical hospital, Multan. SN Comprehensive Clinical Medicine. 2020 Apr;2(4):423-31.
  10. Ramírez-Castillo FY, Moreno-Flores AC, Avelar-González FJ, Márquez-Díaz F, Harel J, Guerrero-Barrera AL. An evaluation of multidrug-resistant Escherichia coli isolates in urinary tract infections from Aguascalientes, Mexico: cross-sectional study. Annals of clinical microbiology and antimicrobials. 2018 Jul 24;17(1):34.
  11. Pandey N, Cascella M. Beta-lactam antibiotics. InStatPearls [Internet] 2023 Jun 4. StatPearls Publishing.
  12. Sangwan J, Lohan K, Mane P, Kumar M. Emerging crisis of multidrug-resistant enterococci from a rural tertiary care hospital of North India. Indian Journal of Health Sciences and Biomedical Research kleu. 2021 May 1;14(2):260-4.
  13. Esposito S, Biasucci G, Pasini A, Predieri B, Vergine G, Crisafi A, et al. Antibiotic resistance in paediatric febrile urinary tract infections. Journal of global antimicrobial resistance. 2022 Jun 1;29:499-506.
  14. Razeghi Z, Goli HR, Salehian M, Gholami M. Evaluation of Antimicrobial Resistance Pattern in Escherichia coli Strains Isolated from Patients Referred to Teaching Hospitals of Mazandaran University of Medical Sciences. Alborz University Medical Journal. 2022 Nov 10;12(1):35-41.
  15. Noble MA. Bailey and Scott’s Diagnostic Microbiology, Betty Forbes, Daniel F. Sahm, and Alice S. Weissfeld. St. Louis, MO: Mosby, 2002, 1069 pp. ISBN 0-323-01678-2. Clinical Chemistry. 2002 Oct 1;48(10):1816-.
  16. Wayne PA. Performance Standards for Antimicrobial Susceptibility Testing. Clinical and Laboratory Standards Institute. 2018.
  17. Duicu C, Cozea I, Delean D, Aldea AA, Aldea C. Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania. Experimental and therapeutic medicine. 2021 Jul;22(1):748.
  18. Raya GB, Dhoubhadel BG, Shrestha D, Raya S, Laghu U, Shah A, et al. Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal. Tropical Medicine and Health. 2020 Aug 3;48(1):65.
  19. Shakya P, Shrestha D, Maharjan E, Sharma VK, Paudyal R. ESBL production among E. coli and Klebsiella spp. causing urinary tract infection: a hospital based study. The open microbiology journal. 2017 Apr 28;11:23.
  20. Ranjbar R, Jafari B, Naji S. Assessing the Antibiotic Resistance Pattern and Determining the Prevalence of Microbial Species in Children with Urinary Tract Infections Referring to Motahari Hospital in Urmia. Scientific Journal of Nursing, Midwifery and Paramedical Faculty. 2019 Jul 20;5(1):24-34.
  21. Fesharakinia A, Malekaneh M, Hooshyar H, Aval M, Gandomy-Sany F. The survey of bacterial etiology and their resistance to antibiotics of urinary tract infections in children of Birjand city. Journal of Scientific Research in Medical Sciences. 2012 Aug 15;19(2):208-15.
  22. Ghorashi Z, Ghorashi S, Soltani-Ahari H, Nezami N. Demographic features and antibiotic resistance among children hospitalized for urinary tract infection in northwest Iran. Infection and drug resistance. 2011 Oct 11:171-6.
  23. Çoban B, Ülkü N, Kaplan H, Topal B, Erdoğan H, Baskın E. Five-year assessment of causative agents and antibiotic resistances in urinary tract infections. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2014 Jun 1;49(2):124.
  24. Mantadakis E, Tsalkidis A, Panopoulou M, Pagkalis S, Tripsianis G, Falagas M, et al. Antimicrobial susceptibility of pediatric uropathogens in Thrace, Greece. International urology and nephrology. 2011 Jun;43(2):549-55.
  25. Hanna-Wakim RH, Ghanem ST, El Helou MW, Khafaja SA, Shaker RA, Hassan SA, et al. Epidemiology and characteristics of urinary tract infections in children and adolescents. Frontiers in cellular and infection microbiology. 2015 May 26;5:45.
  26. Zhang K, Fang X, Zhang Y, Chao M. A retrospective study of uropathogen and its antibiotic resistance among children with urinary tract infection from a single center in China. Heliyon. 2024 Jun 15;10(11).
  27. Khan MA, Mughal IA, Ahmed J, Akhtar W, Behram F. Causative Organisms and Their Sensitivity Pattern of Urinary Tract Infection in Children of a Tertiary Care Hospital. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2024 Nov 9;20(4):664-9.
  28. KAMAL HW, MAHMOOD AE. The prevalence of Escherichia coli causing urinary tract infections in Uncircumcised children under the age of five. International Journal of Pharmaceutical Research (09752366). 2024 Apr 1;16(2).
  29. Noori M, Agha Mohammad S, Ashrafian F, Gholami M, Dabiri H, Goudarzi H. A retrospective cross-sectional study on prevalence and susceptibility pattern of bacterial pathogens causing urinary tract infections at a teaching hospital in Tehran, Iran. Arch Pediatr Infect Dis. 2023 Apr;11(2):e120903.
Journal of Pediatric Perspectives
Volume 13, Issue 8
August 2025
Pages 19593-19604
Files
Share
How to cite
Statistics