Abstract:
Background: The empirical therapy of urinary tract infections (UTI) relies on the
predictability of the agents causing UTI and knowledge of their antimicrobial
susceptibility testing patterns. This information need to be updated regularly. This study
was conducted to assess the spectrum and patterns of antimicrobial resistance of UTI
agents isolated from under-five children presenting with clinical symptoms suggestive of
UTI at district hospitals in Dar es Salaam.
Methods: This was a cross-sectional study with epidemiological and laboratory
components carried out at Amana and Mwananyamala Municipal hospitals.
Epidemiological data was gathered from children's parents /guardian using a structured
questionnaire for socio-dernographic information and antimicrobial drug usage.
Laboratory data included results of urine for culture in Cystine-Lactose-Electrolyte
Deficient (CLED) agar media and susceptibility test done in Mueller Hinton agar using
Kirby Bauer technique.
Results: Of the 270 children, 166 (61.5%) were male, mostly aged less than twelve
months, 72.6% of mothers were housewives. Among cultured mid-stream urine samples,
78 (28.9%) revealed a significant single isolate growth of ~ 105 colon-forming units per
milliliter of urine, 32 (11.9%) had mixed growth, 26 (9.6%) non-significant growth, and
the remainder 134 (49.6%) revealed no bacterial growth. Among the isolated bacteria,
Escherichia coli was the most common isolate 33 (42.3%), followed by Klebsiella spp 31
(39.7%), Streptococcus spp 4 (5.1 %) while 3 (3.8%) were isolated each for
Staphylococcus aureus, Proteus mirabilis and unidentified coliforms. Pseudomonas spp
was isolated only once. The isolated bacteria had high resistance to amoxicillin 79
(98.7%), trimethoprirn-sulfamethoxazole 77 (96.2) and ampicillin 76 (94.9%). They had
low resistance against amikacin 6 (7.7%) and nitrofurantoin 16 (20.5%). Self medication
showed no significant association with the development of multiple drug resistance.
Conclusions and Recommendations: In view of the high drug resistance amongst
bacteria (95 - 98%), therapy should only be advocated, as far as possible, after culture
and susceptibility test has been performed. Based on the results of this study, the
empirical treatment of UTI should be done mostly with nitrofurantoin which revealed
Vlll
lower resistance; also ciprofloxacin can be secondly considered as amikacin has limited
usage to pediatrics due to side effects. Meanwhile more studies are required to get the
baseline susceptibilities pattern of antibiotics to be incorporated in the National guideline
for management of UTI for under-fives.
