Etiological agents and antimicrobial susceptibility patterns of bacterial agents causing urinary tract infection in children aged less than five years, Dar es salaam, Tanzania, 2010

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.