Antibiotic resistance of urinary tract pathogens and rationale for empirical antibiotic therapy in children with urinary tract infection

* Department of Pediatric, College of Medicine, Hawler Medical University, Erbil, Iraq. Introduction Urinary tract infection(UTI) is one of the most common bacterial infections of childhood and it is associated with significant acute morbidity and long term illness such as arterial hypertension and chronic renal failure. It has been suggested that early diagnosis, proper investigation, adequate therapy and prolonged careful follow up in children with UTI may well decrease the number of adults who present with chronic renal failure. In a patient with suspected UTI, antibiotic treatment is usually started empirically before urine culture results are available. To ensure appropriate treatment, knowledge of organism that cause UTI and antibiotic susceptibility is mandatory. In almost all cases there is a need to start treatment before the final microbiological results are available; this will contribute significantly to antimicrobial resistance in uropathogens due to frequent and sometimes repeated misuse of antimicrobials. Area specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and their resistance pattern may help the clinician to choose the correct empirical treatment. The start of empirical therapy ideally be supported by local epidemiological services at each institution to increase the likelihood of therapeutic success, as the etiology of community acquired UTI, and their antibiotic sensitivity has shown geographical variation. With Background and objective: Increased antimicrobial resistance of urinary tract pathogen is a matter of global public health concern. The purpose of this study was to identify the most common bacteria causing urinary tract infection and detection of antibiotics susceptibility of isolates to evaluate the options for empirical antibiotic therapy in children with urinary tract infection in Erbil city. Methods: This study was conducted in Raparin Teaching Hospital on urine samples culture results over a one year period retrospectively. Hospital microbiology recording book was screened. Throughout the study period, 1622 children suspected to have urinary tract infection were investigated for urine culture. Disc diffusion technique according to clinical and laboratory standards institute (CLSI) was performed to determine antibiotics susceptibility of isolated bacteria species. Results: Of 1622 children with suspected urinary tract infection, 514(31.69%) had a positive bacterial culture that included 104 males and 410 females. The most common isolates were E Coli (54.1 %), Staphylococcus (19.1%) and Proteus (12.5%). The most effective antibiotics against isolated pathogens were imipenem, ciprofloxacin and nitrofurantoin with sensitivity rate 95.2%, 78.8% and 74.1% respectively. Conclusion: This study revealed that E. coli and staphylococcal strains were the most frequent isolated pathogens among our population; empirical antibiotic selection should be based on the knowledge of the local prevalence of bacterial organism and antibiotic sensitivity.