Bacterial Agents and Antibiotic Resistance Profile in Pyelonephritis; A Comparison between Children with and without Urinary Tract Abnormalities in the North of Iran
-
Hadi Sorkhi
,
Niloofar Esmaeilzadeh
,
Mahmood Hajiahmadi
,
Peyman Hendizadeh
,
Abazar Pournajaf
,
Mohsen Mohammadi
Abstract
Background: Pyelonephritis in children is a serious condition that is commonly encountered in clinical practice. Urinary tract abnormalities increase the risk of urinary tract infections (UTIs) and consequently antibiotic resistance. Our study aimed to evaluate the local trend in terms of bacterial uropathogen resistance in Babol, Iran, in children with pyelonephritis considering urinary tract abnormalities.
Methods: We recruited pediatric cases aged 1 month to 18 years who were admitted to Amirkola hospital with a diagnosis of pyelonephritis from 2016 to 2019. Children with negative urine cultures or incomplete imaging were excluded from the study. Causative agents were identified based on biochemical features. Antimicrobial in vitro resistance tests were performed using the disk diffusion agar test.
Results: A total of 105 children were included in the study. E. coli was the most common causative agent found in 93 (88.6%) patients. Most of the bacterial isolates were sensitive to amikacin and imipenem, and only 12.4% and 13.3% of isolates were resistant to this antibiotic. On the other hand, nalidixic acid represented the least effective treatment, with a resistance rate of 88.6%. A statistically significant difference was observed in resistance to nitrofurantoin and nalidixic acid between children with and without anomalies (p < 0.05).
Conclusion: High antibiotic resistance, especially in children with urinary tract anomalies, was identified for frequently used antibiotics. Our findings provide important implications regarding local patterns of uropathogens and antibiotic resistance in children with pyelonephritis.
2. Marcus N, Ashkenazi S, Samra Z, Cohen A, Livni G. Community-acquired enterococcal urinary tract infections in hospitalized children. Pediatr nephrol 2012; 27(1):109-14.
3. Upadhyay J, Bolduc S, Braga L, Farhat W, Bägli DJ, McLORIE GA, et al. Impact of prenatal diagnosis on the morbidity associated with ureterocele management. J Urol 2002; 167(6):2560-5.
4. Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1987; 1(4):713-30.
5. Downs SM. Technical report: urinary tract infections in febrile infants and young children. Pediatrics 1999; 103(4):e54-e.
6. Ghiro L, Cracco A, Sartor M, et al. Retrospective study of children with acute pyelonephritis. Nephron 2002; 90(1):8-15.
7. Wald E. Urinary tract infections in infants and children: a comprehensive overview. Curr opin pediatr 2004; 16(1):85-8.
8. Yousefichaijan P, Rezagholizamenjany M, Rafiei F, et al. The relationship between blood biomarkers level and the prognosis of nephrotic syndrome in the children. Int J Pediatr 2016; 4(9):3489-97.
9. Shaikh KJ, Osio VA, Leeflang MM, et al. Procalcitonin, C‐reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. CDSR 2020; 9.
10. Morello W, La Scola C, Alberici I, et al. Acute pyelonephritis in children. Pediatr Nephrol 2016; 31(8):1253-65.
11. Montini G, Toffolo A, Zucchetta P, et al. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. Bmj 2007; 335(7616):386.
12. Neuhaus TJ, Berger C, Buechner K, et al. Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis. Euro J pediatr 2008; 167(9):1037-47.
13. Shaikh N, Craig JC, Rovers MM, et al. Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA pediatr 2014; 168(10):893-900.
14. Alberici I, Bayazit AK, Drozdz D, et al. Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group. Euro J pediatr 2015; 174(6):783-90.
15. Hewitt IK, Montini G. Pediatric febrile urinary tract infections: the current state of play. Ital J pediatr 2011; 37(1):1-3.
16. Rezagholi-Zamnjany M, Yousefichaijan P. An overview on peritoneal dialysis. Ann Res Dial 2016; 1(1).
17. Strohmeier Y, Hodson EM, Willis NS, et al. Antibiotics for acute pyelonephritis in children. CDSR 2014;7.
18. Yousefichijan P, Dorreh F, Zamenjany MR. Bartter’s syndrome type 5; a case report. J Ren Inj Prev 2017; 6(4):244-6.
19. Tankhiwale SS, Jalgaonkar SV, Ahamad S, et al. Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res 2004; 120(6):553-6.
20. Stein R, Dogan HS, Hoebeke P, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015; 67(3):546-58.
21. Mishra OP, Abhinay A, Prasad R. Urinary infections in children. Indian J Pediatr 2013; 80(10):838-43.
22. White B. Diagnosis and treatment of urinary tract infections in children. Am fam physician 2011; 83(4):409-15.
23. Shigemura K, Ishikawa K. AAUS guideline for acute uncomplicated pyelonephritis. J Infect Chemother 2022. 28(8):1092-7.
24. Prabhu A, Taylor P, Konecny P, et al. Pyelonephritis: what are the present day causative organisms and antibiotic susceptibilities? Nephrology 2013; 18(6):463-7.
25. Czaja CA, Scholes D, Hooton TM, et al. Population-based epidemiologic analysis of acute pyelonephritis. Clin infect dis 2007; 45(3):273-80.
26. Flor-de-Lima F, Martins T, Teixeira A, et al. Etiological agents and antimicrobial susceptibility in hospitalized children with acute pyelonephritis. Acta Méd Port 2015; 28(1):15-20.
27. Duicu C, Cozea I, Delean D, et al. Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania. Exp Ther Med 2021; 22(1):1-7.
28. Hosseinzadeh K, Azimian J. Iranians’ self-report knowledge and practice about arbitrary use of antibiotics. J Clin Diagn Res 2017; 11(8):FC06.
29. Koçak M, Büyükkaragöz B, Çelebi Tayfur A, et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016; 58(6):467-71.
30. Alper BS, Curry SH. Urinary tract infection in children. Am Fam Physician 2005; 72(12):2483-8.
31. Twaij M. Urinary tract infection in children: a review of its pathogenesis and risk factors. J. R. Soc. Promot. Health 2000; 120(4):220-6.
| Files | ||
| Issue | Vol 11 No 3-4 (2023) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jmb.v11i3-4.14366 | |
| Keywords | ||
| Pyelonephritis Children urinary tract abnormality antibiotic resistance. | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
