Changes in Antimicrobial Resistance Patterns of Pediatric Uropathogens in the South of Iran

Background: The increasing prevalence of antimicrobial resistance has emerged as a critical global public health issue. This study aimed to identify the predominant bacterial pathogens causing community-acquired urinary tract infections (UTIs) in children and to evaluate the evolving patterns of antimicrobial resistance among pediatric uropathogens in Shiraz, southern Iran.Methods: This research involved two prospective cross-sectional studies conducted among pediatric patients diagnosed with UTIs. The first study was carried out from ۲۰۰۵ to ۲۰۰۶ and included ۴۳۵ children, while the second study, conducted from April ۲۰۱۰ to March ۲۰۱۱, enrolled۱۷۵ children. Participants were children aged ۱ month to ۱۰ years suspected of having UTIs and referred to various outpatient pediatric clinics. Informed consent was obtained, and demographic data and laboratory test results were recorded using a standardized checklist. Urine samples were collected via urine bags for children under ۲ years old and midstream clean-catch for older children. Patients were included if they presented with pyuria (white blood cell count >۱۰ cells/µL) and UTI symptoms, such as dysuria, frequency, fever, etc. Bacterial culture was performed on blood agar and eosin methylene blue (EMB) agar, followed by antimicrobial susceptibility testing on isolated pathogens. Data were analyzed using SPSS version ۱۹. Statistical analysis involved Pearson correlation and Chi-square tests, with a p-value of less than ۰.۰۵ considered significant.Results: In the initial study (۲۰۰۵-۲۰۰۶), Escherichia coli was the most common pathogen (۶۹.۲%), followed by Klebsiella (۱۳.۳۳%) and Enterobacter (۱۲.۱۸%). The male-to-female ratio was ۰.۴۱۷, with the highest infection rate in infants under ۱۲ months (p = ۰.۰۰۲). Resistance was highest for Amoxicillin (۹۳.۸۳%), Ampicillin (۸۴.۳۹%), Co-trimoxazole (۶۰%), and Cephalotin (۵۸.۷۱%), and lowest for Nitrofurantoin (۱۲.۶۳%) and Ciprofloxacin (۷.۷۷%). In the follow-up study (۲۰۱۰-۲۰۱۱), E. coli remained dominant (۶۷.۴۳%), followed by Proteus (۱۱.۴۳%) and Klebsiella (۶.۸۵%). The male-to-female ratio was ۰.۲ and infections were highest in children under ۱۲ months (p = ۰.۰۱۶). Resistance increased for Co-trimoxazole (۶۴.۸۵%), Cefixime (۵۳.۴۲%), Nalidixic acid (۵۲.۹۸%), and Nitrofurantoin (۴۴.۷۷%), while moderate resistance was noted for Gentamicin (۳۹.۱۹%) and Ciprofloxacin (۲۲.۵۵). A significant association existed between bacterial type and age groups in the second study (p = ۰.۰۰۲).Conclusion: An upward trend in resistance was observed for commonly used oral antibiotics such as Co-trimoxazole, Cefixime, Nalidixic acid, and Nitrofurantoin. However, resistance remained lower for parenteral agents including Gentamicin, Cefotaxime, Ceftizoxime, and Ciprofloxacin. This highlights the ongoing challenge in selecting effective empirical antibiotic therapies for pediatric UTIs.

کلیدواژه ها:

Antibiotic ، Pediatric ، Resistance ، Urinary tract infection