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Indian Pediatr 2013;50: 707 |
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Bacteriology and Antibiotic Resistance Pattern
in Community Acquired Urinary Tract Infection
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Rajiv Sharan, Dhananjay Kumar and B Mukherjee
Tata Motors Hospital, Jamshedpur, Jharkhand, India.
Email:
[email protected]
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Extensive use of antibiotics have
resulted in development of resistance among most commonly used drugs in
community acquired urinary tract infection (UTI). This study was
conducted to identify the resistance pattern in community acquired UTI
.We collected urine for routine examination and culture from suprapubic
urine in all the cases to avoid any contamination.
E. Coli was the most common organism identified. Among oral
antibiotics, there was high degree of resistance to penicillin group and
cephalosporin groups. Among parentral antibiotics, all the
cephalosporins were variably resistant except cephaperazone-salbactum.
Key Words: Antibiotic resistance, Cephalosporins,
UTI.
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Urinary tract infections (UTIs) are
often treated with different broad-spectrum antibiotics when
one with a narrow spectrum of activity may be appropriate
[1,2]. Indian Academy of Pediatrics in its revised update on
UTI has recommended cephalosporins in oral and parental
forms as the first line of therapy [3].
The resistance pattern of community
acquired UTI pathogens has not been studied extensively in
India [4]. We conducted this study to compare the frequency
and drug resistance pattern in uropathogenes isolated from
children of < 5yrs with community acquired UTIs in
Jamshedpur, India and to compare the treatment modalities
with the recommendation of IAP. Detailed history and
complete clinical examination was carried out. The urine
specimen was collected in sterile tube through suprapubic
approach for investigation. Enrolled cases were grouped
under two age groups; upto 2 years, and above 2 years. The
Ethics Committee approved the study.
64 children with urine culture positive
cases were analyzed. In children less than 2 years, the most
common symptoms were fever, diarrhea, and excessive cry. In
children between 2 to 5 years of age the most common
complaints were fever, dysuria and pain abdomen. E. Coli
was the most common organism followed by Klebsiella,
Proteus and Pseudomonas. E. coli was most
commonly sensitive to nitrofurantoin, followed by
levofloxacin, ofloxacin and azithromycin. High degree of
resistance was seen for penicillin and cephalosporin groups
of drugs. Among parentral antibiotics,x the most sensitive
antibiotic was aminoglycosides (amikacin and gentamicin) and
high degree of resistance was seen for cephalosporins.
Detailed drug sensitivity is shown in Table I.
TABLE I Antibiotic Resistance Pattern In Childhood UTI
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Antibiotics |
E Coli |
Klebsiella
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Others |
P-
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(49) |
(5) |
(10) |
Value |
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Amoxicillin |
48 (98%) |
4 (80%) |
10 (100%) |
0.074 |
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Augmentin |
43 (88%) |
3 (60%) |
4 (40%) |
0.002 |
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Cephalexin |
42 (85.8%) |
3 (60%) |
10 (100%) |
0.110 |
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Ciprofloxacin |
31 (63.3%) |
2 (40%) |
6 (60%) |
0.596 |
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Norfloxacin |
41 (83.7%) |
1 (20%) |
7 (70%) |
0.005 |
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Ofloxacin |
13 (26.6%) |
0 |
7 (70%) |
0.112 |
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Septran |
37 (75.6%) |
3 (60%) |
9 (90%) |
0.406 |
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Azithromycin |
14 (28.6%) |
0 |
3 (30%) |
0.373 |
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Levofloxacin |
3 (6.2%) |
0 |
4 (40%) |
0.005 |
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Nitrofurantoin |
0 |
1 (20%) |
4 (40%) |
0.000 |
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Amikacin (iv) |
10 (21.4%) |
0 (0%) |
3(30%) |
0.396 |
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Ceftazidime (iv) |
30 (61.3%) |
2 (40%) |
9(90%) |
0.114 |
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Cefuroxime (iv) |
33 (67.4%) |
2 (40%) |
8 (80%) |
0.298 |
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Gentamicin (iv) |
8 (16.4%) |
0 (0%) |
4 (40%) |
0.116 |
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Magnex (iv) |
10 (21.4%) |
0 (0%) |
3(30%) |
0.396 |
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Imipenem (iv) |
20 (41.9%) |
2 (40%) |
8 (80%) |
0.073 |
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Meropenem (iv) |
19 (38.8%) |
1 (20%) |
7 (70%) |
0.110 |
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Cefotaxime (iv) |
36 (73.5%) |
3 (60%) |
7(70%) |
0.807 |
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Ceftriaxone (iv) |
36 (73.5%) |
2 (40%) |
9(90%) |
0.118 |
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Pipzo (iv) |
21 (42.2%) |
0 (0%) |
4 (40%) |
0.173 |
The evolution of resistance among
antibiotic is not a new phenomenon. The high degree of
resistance needs to be reviewed in the light of our report
as cephalosporins are among the highly prescribed drugs over
the counter .This adds to inadequate treatment, high degree
of resistance and increased cost of treatment [5]
Contributors: All the authors
designed, contributed and approved the study.
Funding:Tata Motors; Competing
interests: None stated.
References
1. Schaeffer AJ. The expanding role of
fluoroquinolones. Am J Med. 2002;113:45S-54S.
2. Biswas D, Gupta P, Prasad R, Singh V,
Arya M, Kumar A. Choice of antibiotic for empirical therapy
of acute cystitis in a setting of high antimicrobial
resistance. Indian J Med Sci. 2006,60:53-8.
3. Indian Society of Pediatric
Nephrology. Revised Statement on Management of Urinary Tract
Infections. Indian Pediatr. 2011;48: 709-17.
4. Gupta V, Yadav A, Joshi RM. Antibiotic
resistance pattern in uropathogen. Indian J Med Microbiol.
2002;20:96-8.
5. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD.
Effect of antibiotic prescribing in primary care on
antimicrobial resistance in individual patients: systematic
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