Bacterial Pathogens and Antimicrobial Susceptibility in Paediatric Urinary Tract Infections at Teaching Hospital Jaffna

Abstract

Background: Urinary tract infections (UTIs) are a significant health concern among children. Which may result in renal injury later. Assessing the type of pathogens and their Antibiotic Susceptibility Test (ABST) patterns locally is crucial for the effective treatment of UTIs. Objective: To assess the prevalence and ABST patterns of bacterial pathogens in UTI suspected pediatric patients at the outpatient department of Teaching Hospital Jaffna Methods: A descriptive cross-sectional study was conducted from May-July, 2024, using convenience sampling. Clean-catch midstream urine samples were collected from UTI suspected pediatric patients. Significant bacterial growth (SBG) was defined as growth of a single organism at >10⁴ CFU/mL on cysteine lactose electrolyte-deficient agar, with pyuria (>1 pus cell/7 high- power field) as supporting evidence. Isolates were identified biochemically, and ABST was performed using CLSI disk diffusion method. Extended-Spectrum Beta-Lactamase (ESBL) detection employed the keyhole synergy test with cefotaxime, ceftazidime, and amoxicillin- clavulanic acid discs, while Methicillin-Resistant Staphylococcus aureus (MRSA) was identified via cefoxitin disk diffusion. Descriptive statistics were done with SPSS version 20.0. Results: Among the 156 pediatric patients suspected of having UTIs, 101 were female, mean±SD age was 6.3±3.5 years. The SBG was found in 10.9% of samples (76.5% female), primarily coliforms (Escherichia coli 35.3%, Klebsiella species 23.5%). Norfloxacin, gentamicin, co- trimoxazole, and nitrofurantoin were identified as highly effective first-line antibiotics. Coliforms showed high resistance to cefotaxime (80%) and ampicillin (70%), with moderate resistance to nalidixic acid and co-amoxiclav (50% each), with 20% being ESBL producers. Enterococcus and other Streptococcus species were sensitive to most empirical antibiotics, however isolated Staphylococcus aureus (5.9%) was identified as MRSA. Conclusion: Escherichia coli was the most common isolate among pediatric UTI suspected cases. Isolated pathogens showed high resistance to commonly used antibiotics.