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| A decade of trends in the distribution and antimicrobial susceptibility of prevalent uropathogens among pediatric patients from Tehran, Iran during 2005-2016 |
Ali Reza Nateghiana,Sina Karajib,Khosrow Zamanic,d,*( )
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a Ali Asghar Clinical Research Development Center (AACRDC), Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
b General PractitionerAli Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
c Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
d Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran |
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Abstract Objectives: To determine changes in the distribution of uropathogens and their antimicrobial resistance in pediatric patients in a children's hospital from 2005 to 2016.
Methods: A cross-sectional analysis of uropathogens and their antimicrobial resistance within inpatient children was performed over the 11-year period, 2005 to 2016, in Ali Asghar children's hospital. The rate of antibiotic resistance among patients was evaluated according to demographic data including age, sex, urinary tract abnormities and history of antibiotic consumption.
Results: In total, 958 female and 349 male positive cultures were analyzed. Escherichia coli (E. coli) (77.6%) was the most common causative agent of urinary tract infection (UTI) in children and Klebsiella pneumoniae (10.4%), Pseudomonas aeruginosa (2.4%), and Enterococcus spp (2.4%) were less frequent isolated bacteria. The resistance rates of E. coli isolates were increased against amikacin, ceftriaxone, ceftazidime, ciprofloxacin, cotrimoxazole and imipenem from 2005 to 2010. However, we observed a decreasing trend for some of antibiotics including amikacin, gentamicin, imipenem, ceftazidime and cotrimoxazole during 2014-2016. The rate of antibiotic resistance was greater in boys than in girls against many antibiotics. The rate of resistance to amikacin, gentamicin, nitrofurantoin and cotrimoxazole in patients aged <1 year was higher than other age groups (p<0.001). A higher antibiotic resistance rate was observed in patients with anatomical abnormality and those who have had a history of antibiotic consumption.
Conclusion: The study indicated the significant decrease in E. coli antibiotic resistance in the last 3 years. An effective empirical treatment regime should be based on local epidemiology and antimicrobial susceptibility testing.
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Received: 05 November 2019
Available online: 29 May 2020
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Corresponding Authors:
Khosrow Zamani
E-mail: zamanikh@yahoo.com
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| Microorganisms | Number (%) | | Gram-negative bacteria | | Escherichia coli | 1014 (77.6) | | Klebsiella pneumoniae | 140 (10.71) | | Pseudomonas aeruginosa | 32 (2.44) | | Proteus spp | 15 (1.14) | | Enterobacter spp | 13 (1.0) | | Acinetobacter spp | 3 (0.23) | | Other Gram-negative bacteria | 8 (0.61) | | Gram-positive bacteria | | Enterococcus spp | 32 (2.44) | | Coagulase-negative staphylococci | 29 (2.21) | | Staphylococcus aureus | 5 (0.4) | | Other streptococci | 14 (1.07) | | Other Gram-positive bacteria | 2 (0.15) | | Total | 1307 (100) |
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Frequency of uropathogens isolated from urine cultures.
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| Antibiotics | Escherichia coli | Klebsiella pneumoniae | Pseudomonas aeruginosa | Enterococcus spp | | %R | TN | %R | TN | %R | TN | %R | TN | | Amikacin | 6.95 | 950 | 24.62 | 130 | 6.9 | 29 | 71.43 | 7 | | Gentamicin | 19.02 | 936 | 29.46 | 129 | 24.14 | 29 | 85 | 20 | | Ampicillin | 78.75 | 607 | 88.68 | 106 | 100 | 14 | 40.91 | 22 | | Cefazolin | 56.33 | 529 | 76.09 | 100 | 82.35 | 17 | - | - | | Cephalexin | 52.28 | 329 | 57.14 | 21 | 100 | 7 | - | - | | Cefuroxime | 53.23 | 387 | 60 | 70 | 92.31 | 13 | - | - | | Ceftizoxime | 29.09 | 55 | 33.33 | 3 | - | - | - | - | | Ceftazidime | 28.38 | 613 | 41.94 | 93 | 20.83 | 24 | - | - | | Cefotaxime | 37.75 | 355 | 55.56 | 27 | 75.0 | 12 | - | - | | Ceftriaxone | 36.08 | 898 | 46.28 | 121 | 46.15 | 26 | - | - | | Cefepime | 15.58 | 552 | 24.72 | 89 | 11.11 | 18 | - | - | | Imipenem | 13.16 | 395 | 4.55 | 44 | 6.25 | 16 | - | - | | Ciprofloxacin | 19.66 | 829 | 7.89 | 114 | 4 | 25 | 60 | 20 | | Ofloxacin | 31.11 | 135 | 15.38 | 13 | 0 | 4 | 20 | 5 | | Cotrimoxazole | 60.24 | 835 | 40.17 | 117 | 81.82 | 22 | 73.68 | 19 | | Nitrofurantoin | 2.93 | 957 | 17.42 | 132 | 83.87 | 31 | 16.67 | 18 | | Nalidixic acid | 46.43 | 420 | 18.42 | 38 | 76.92 | 13 | 42.86 | 7 | | Erythromycin | - | - | - | - | - | - | 76.92 | 26 |
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The pattern of antibiotic resistance for selected uropathogens.
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| Antibiotics | Boys | Girls | p-Value | | Number (%) of resistant isolates | Total number of isolates | Number (%) of resistant isolates | Total number of isolates | | Amikacin | 51 (16.8) | 303 | 64 (7.5) | 859 | <0.001 | | Ampicillin | 169 (83.7) | 202 | 443 (75.9) | 584 | <0.021 | | Ceftriaxone | 140 (47.5) | 295 | 285 (34.9) | 816 | <0.001 | | Ceftazidime | 81 (38.9) | 208 | 147 (26.5) | 554 | <0.001 | | Nitrofurantoin | 47 (14.8) | 317 | 50 (5.6) | 891 | <0.001 | | Gentamicin | 98 (31.8) | 308 | 160 (18.3) | 874 | <0.001 | | Ciprofloxacin | 60 (21.5) | 279 | 134 (17.5) | 765 | <0.142 | | Imipenem | 20 (16.1) | 124 | 38 (10.7) | 355 | <0.11 | | Cotrimoxazole | 156 (54.4) | 287 | 456 (58.3) | 782 | <0.247 |
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Distribution and frequency of antibiotic resistance uropathogens by gender.
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| Antimicrobial agent | 2005-2007 | 2008-2010 | 2011-2013 | 2014-2016 | p-Value | | Resistance percentage | Total number | Resistance percentage | Total number | Resistance percentage | Total number | Resistance percentage | Total number | | Amikacin | 9.2% | 142 | 13.6% | 213 | 7.6% | 249 | 1.4% | 346 | <0.001 | | Ampicillin | 66.7% | 6 | 90% | 50 | 81% | 211 | 75.9% | 340 | 0.058 | | Ceftriaxone | 30.5% | 128 | 42.6% | 216 | 44.7% | 215 | 28.6% | 339 | <0.001 | | Ceftazidime | 25.8% | 62 | 46.3% | 41 | 40.5% | 173 | 20.5% | 337 | <0.001 | | Ciprofloxacin | 14.1% | 64 | 21.4% | 187 | 23% | 243 | 17.3% | 335 | 0.027 | | Cotrimoxazole | 65.5% | 139 | 70.8% | 192 | 70.6% | 221 | 42.4% | 283 | <0.001 | | Gentamycin | 18.4% | 136 | 28.4% | 211 | 24.2% | 260 | 9.1% | 329 | <0.001 | | Imipenem | 8.3% | 36 | 18.2% | 214 | 10.5% | 86 | 1.7% | 59 | 0.005 | | Nitrofurantoin | 6.7% | 134 | 6% | 216 | 2.3% | 263 | 0.0% | 344 | <0.001 |
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Antimicrobial resistance trends among Escherichia coli isolates from Ali Asghar Hospital, 2005 to 2016.
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| Organisms | Patients with abnormalities, n (percent of isolates, %) | Patients without anatomical abnormalities, n (percent of isolates, %) | | Escherichia coli | 350 (73.3) | 618 (80.7) | | Klebsiella pneumoniae | 51 (10.6) | 79 (10.3) | | Pseudomonas aeruginosa | 23 (4.8) | 7 (0.9) | | Enterococcus. spp | 11 (2.3) | 17 (2.2) | | Enterobacter. spp | 9 (1.8) | 4 (0.5) | | Proteus. spp | 6 (1.2) | 9 (1.2) | | Coagulase-negative staphylococci | 8 (1.6) | 9 (1.2) | | Others | 19 (3.9) | 23 (3) |
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Distribution of UTI etiological agents in patients with and without anatomical abnormalities.
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| Antimicrobial agent | Patients without anatomical abnormalities | Patients with anatomical abnormalities | p-Value | | Number (%) of resistant isolates | Total number of isolates | Number (%) of resistant isolates | Total number of isolates | | Amikacin | 57 (8.4) | 677 | 51 (12.0) | 426 | 0.053 | | Ampicillin | 366 (76.3) | 480 | 215 (79.9) | 269 | 0.247 | | Cefazolin | 221 (53.3) | 415 | 157 (72.7) | 216 | 0.0002 | | Cefepime | 65 (15.6) | 417 | 55 (22.2) | 248 | 0.032 | | Cephalexin | 103 (45.8) | 225 | 95 (67.4) | 141 | 0.0005 | | Ceftriaxone | 208 (32.3) | 644 | 196 (47.2) | 415 | 0.0001 | | Ceftazidime | 118 (26.8) | 441 | 101 (35.4) | 285 | 0.0128 | | Ciprofloxacin | 94 (15.0) | 627 | 83 (22.7) | 365 | 0.0021 | | Cotrimoxazole | 361 (57.6) | 627 | 224 (57.6) | 389 | 0.998 | | Gentamicin | 130 (18.6) | 699 | 111 (26.2) | 424 | 0.0027 | | Imipenem | 27 (10.1) | 267 | 28 (15.1) | 185 | 0.108 | | Nitrofurantoin | 45 (6.3) | 715 | 44 (10.1) | 434 | 0.0181 |
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Distribution of resistant isolates of Escherichia coli among patients with and without anatomical abnormalities.
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| Antibiotics | Previous antibiotic consumption (+) | Previous antibiotic consumption (-) | p-Value | | Number (%) of resistant isolates | Total number | Number (%) of resistant isolates | Total number | | Ampicillin | 16 (8.9) | 180 | 6 (4.9) | 22 | 0.192 | | Amikacin | 103 (82.4) | 125 | 66 (68.8) | 96 | 0.017 | | Cefepime | 25 (23.4) | 107 | 5 (5.5) | 91 | 0.0004 | | Cephalexin | 36 (52.9) | 68 | 9 (32.1) | 28 | 0.063 | | Cefotaxime | 31 (43.7) | 71 | 7 (24.1) | 29 | 0.067 | | Ceftriaxone | 73 (42.2) | 173 | 33 (27) | 122 | 0.008 | | Ceftazidime | 34 (31.8) | 107 | 14 (15.4) | 91 | 0.007 | | Ciprofloxacin | 36 (21.1) | 171 | 15 (12.9) | 116 | 0.077 | | Cotrimoxazole | 102 (60.7) | 168 | 43 (41.3) | 104 | 0.002 | | Gentamicin | 40 (20.8) | 192 | 19 (15.4) | 123 | 0.231 | | Imipenem | 10 (11.4) | 88 | 2 (4.3) | 47 | 0.166 | | Nalidixic acid | 41 (49.4) | 83 | 8 (22.9) | 35 | 0.008 | | Nitrofurantoin | 16 (8.3) | 193 | 4 (3.2) | 126 | 0.065 |
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Association of previous antibiotic consumption and antibiotic resistance.
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