Prevalence, Antimicrobial Susceptibility Patterns and Associated Factors of Bacterial Uropathogens Among Clinically Urinary Tract Infection Suspected Children Attending Arba Minch General Hospital, southern Ethiopia

Abstract

BACKGROUND: Urinary tract infections are the most commonly occurred bacterial infections in children. If not promptly diagnosed and appropriately treated, it may lead to severe consequences such as urosepsis as well as renal damage. Antimicrobial resistant bacterial uropathogens are rapidly emerging. Literature shows that studies in this regard are scanty in southern Ethiopia, particularly in the study area, Arba Minch. OBJECTIVE: To assess the bacterial profile, antimicrobial susceptibility patterns and associated factors among urinary tract infection suspected children attending at Arba Minch General Hospital, southern Ethiopia. METHODS: An institutional based cross sectional study was carried out from 1st October, 2020 to 31st January, 2021 at Arba Minch General Hospital, Arba Minch town. Socio-demographic and clinical data of patients’ were collected by pretested questionnaire. In order to quantify the bacteria (as per the Kass count, >105CFU/ml), midstream urine samples were collected in sterile urine cups and streaked onto CLEF and MacConkey agars. Isolates were identified by standard microbiological methods. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion techniques as per clinical laboratory standard institute. ES BL production was detected by double disc synergy test. Data were analyzed by Statistical Package for Social Services, version 20. P-value less than or equal to 0.05 in multivariable analysis was considered as significant. RESULTS: A total of 246 children were included; of them 55.7% were males. Of the total participants, 38 (15.4%) were found to be positive for significant bacteriuria. Isolates of E. coli, 9/38 (23.7%) and S. aureus, 9/38 (23.7%) were the most predominant ones followed by K. pnumoniae, 4/38 (10.5%). Majority of the Gram-negative bacterial isolates showed resistance toward amoxicillin-clavulanate (89.5%), ampicillin (84.6%), ceftazidime (81%) and cefuroxime (78.9%). Likewise, 76.9%, 76.5%, and 70.6% of Gram-positive bacteria respectively showed resistance toward cotrimoxazole, tetracycline and penicillin. Interestingly, nitrofurantoin (91.8%) and ciprofloxacin (83.5%) were effective against both groups. MDR was detected in 68.4% of the total isolates. ES BL production was detected in 57.1% of Gram-negative bacteria, whereas 55.6% of S. aureus were MESA. UN-circumcision in male was significantly associated with UTI ([(AOR= 3.578; 95% CI: 1.263 – 10.134; p=0.016)]) CONCLUSIONS: Prevalence of US in our study was relatively high. Isolates of E. coli and S. aureus were the most prevalent pathogens. The frequently used antibiotics in the study area, particularly matrimonial, encountered high rate of resistance. Nitrofurantoin and ciprofloxacin were effective against pathogens. UN-circumcision in males predispose to UTI. Continuous surveillance on the prevalent uropathogens and their antibiotic resistance patterns as well as infection prevention measures should be regularly performed to reduce the occurrence of UTI and to handle the current upsurge in antibiotic resistance.