Changes of antibiotic pattern in Iranian children with urinary tract infection

Introduction: Knowledge of local antimicrobial resistance patterns is essential for evidence-based empirical antibiotic prescribing .Resistance patterns to antimicrobial agents vary according to the geographic region ; consequently, the choice of antimicrobial empiric treatment should not only be based on the most likely urinary tract pathogens but also on their updated local resistance patterns Materials and Methods: A retrospective analysis of the antimicrobial resistance within inpatient children with the positive urine isolates and final diagnosis of UTI over the 12 year period, 2005 to 2017, in Ali Asghar Children s Hospital was performed.Results: In total, 958 female and 349 male positive cultures were analysed. E. coli(77.6%) was the most common causative agent of UTI in children .The overall resistance rates were as follows: Ampicillin(78%) , Cefazolin(60%) , Cotrimoxazole(57%) , Cephalexin(54%), NalidixicAcid(44%) , Ceftriaxon(38%) , Gentamycin(22%) , Ciprofloxacin(18.6%) Cefepime(18.1%) , Imipnem(12%) , Amikacin(10%) , Nitrofurantoin(8%). E.coli Resistance rate increasing significantly over the 2008 to 2011 altough Our study detected the least E.coli Resistance rate over 2015 to 2017. Higher antibiotic resistance rates was identified in the male population with the exception of cotrimoxazole. Overall resistance to Cotrimoxazole was related to age: 51 % below and 61 % above 1 year (p <0.001) and Resistance rate were higher to Amikacin,Gentamycin,Nitrofurantoin in (below 1 year old) children. Higher antibiotic resistance rates was identified in patient with anatomical abnormality and there is significantly association between Positive Antibiotic history in the past two weeks and higher resistance rate among Cephalosporins , Ampicillin, Cotrimoxazole and NalidixicAcid.Conclusion: anatomical abnormality , previous Antibiotic History,Age and Gender were among the risk factors associated with antimicrobial resistance. Statistical analysis of the resistance pattern trend during 12 years indicated the significant decrease in E.coli antibiotic resistance in the last three years. Decisions about empirical therapy for UTI are best made on a case-by-case basis based upon the demographic and clinical risk factors for higher resistance rates

Keywords:

Urinary Tract Infections , Antimicrobial Drug Resistance , Pediatrics , Ali Asghar Children s Hospital