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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 1249-1252
A five-year etiology and antimicrobial susceptibility patterns of urinary pathogens in children at Princess Rahmah Hospital, Jordan


Assistant Professor of Pharmacology, Faculty of Nursing, Irbid National University, Irbid, Jordan

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Date of Web Publication8-Nov-2011
 

How to cite this article:
Al-Shara M. A five-year etiology and antimicrobial susceptibility patterns of urinary pathogens in children at Princess Rahmah Hospital, Jordan. Saudi J Kidney Dis Transpl 2011;22:1249-52

How to cite this URL:
Al-Shara M. A five-year etiology and antimicrobial susceptibility patterns of urinary pathogens in children at Princess Rahmah Hospital, Jordan. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Nov 22];22:1249-52. Available from: http://www.sjkdt.org/text.asp?2011/22/6/1249/87247
To the Editor,

Increasing rates of resistance among bacterial uropathogens has become a major public health problem in both developed and developing countries. [1] Several factors are associated with the rise of resistance rate of bacterial uropathogens including misuse of antimicrobials, [2] frequent oral use of wide-spectrum antimicrobials that may change the intestinal flora, (which is usually common cause of urinary tract infection [UTI]), [2],[3],[4] and inappropriate dosages and duration of treatment. [5] Although there were many studies on uro-pathogens and their susceptibility patterns in children conducted in Jordan, [6],[7],[8],[9] it's necessary to re-evaluate the uropathogens resistant pattern.

We reviewed the laboratory records for the period of January 1, 2005, through December 31, 2009, at Princess Rahmah Hospital located in Irbid, Jordan. Urine specimens were derived from children patients (≤15 years of age) on the wards or attending outpatient clinics. Quantitative bacteriologic cultures were performed according to standard laboratory procedures. [10]

The prevalence of isolation was relatively stable during the study period for the most of uro-pathogen isolates i.e. E. coli (69.5%), Klebsiella spp. (19.9%), Psedomonas spp. (1.8%), Staphylococcus aureus (1.6%), and Streptococcus spp. (0.7%), [Table 1]. Isolation rate of proteus spp. decreased gradually from (5.0%) during 2005 through (3.1%) during 2009. On the contrary, the isolation rate of Enterobacter spp. increased from (2.8%) during 2005 through (5.5%) during 2009.
Table 1: Frequency of isolation of causative organisms of UTI in children.

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Nearly 87% of all uro-pathogens were susceptible to ciprofloxacin and this susceptibility rate was almost homogenous throughout the 2005 through 2009 study period. Susceptibility to norfloxacin and gentamicin was better maintained than that of other tested antimicrobials during the study period. Gradual improvement in susceptibility of uro-pathogens was to cefixime, whereas susceptibility of uro-pathogens showed gradual decline to amoxicillin-clavulanic acid, cephalothin, co-trimoxazole, and nalidixic acid during the study period. However, in over all tested uro-pathogens, the highest resistant rate (nearly 90%) was to ampicillin.

During the year of 2005 and 2009, significant decline in susceptibility of E. coli strains to cephalothin, cefotaxime, and nalidixic acid (P <0.05). Klebsiella spp. showed significant decline in their susceptibility to amoxicillinclavulanic acid and cefotaxime (P<0.05). However, both E. coli and Klebsiella spp. showed significant improvement in their susceptibility to cefixime.

This current study provides information regarding the main uro-pathogens in children (inpatients and outpatient setting) and their antimicrobial susceptibility patterns. The occurrence ratio between female to male patients was (4.6: 1) which agrees with those reported in Jordan. [6],[7],[8],[9],[11],[12]

The leading pathogens in our study were similar to those reported in Jordan [6],[7],[8],[9],[11],[13] and elsewhere. [14],[15],[16],[17] The prevalence of isolation was relatively stable during the study period for the most of uro-pathogen isolates except for Proteus spp., which decreased gradually from 5.0% during 2005 to 3.1% during 2009 and Enterobacter spp., which significantly increased from 2.8% during 2005 to 5.5% during 2009 (P <0.05).

In this study, the most effective antimicrobials were consistent with those reported from other studies. [6],[7],[11],[18] High resistance rate to ampicillin, amoxicillin-clavulanic acid, and cotrimoxazole may be due to the widely use of these antibacterial drugs in the world including Jordan. [19]

These results also revealed a decrease in susceptibility rate for most of antimicrobial used in this study than that reported previously in the medical literature. [8],[11],[18] Our data also showed a significant improvement in suscepti-bility E. coli isolates to cefixime during 2005 and 2009 (from 53.2 to 75.3%). However, Klebsiella spp. exhibited stable susceptibility to most antibiotics tested. These results are in agreement with other studies reported elsewhere. [1],[20]

In conclusion, urinary isolates in children were mainly  Escherichia More Details coli organisms which are developing resistance to commonly used antimicrobials. This emergence of multiple drug resistance calls for a continuous monitoring and reviewing of antimicrobial policy in the hospital and the country at large.

 
   References Top

1.Dromigny JA, Nabet P, Gros-Claude JD. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother 2005;56:236-9.  Back to cited text no. 1
    
2.Col NF, O'Connor RW. Estimating worldwide current antibiotic usage: report of task force 1. Rev Infect Dis 1987;9(Suppl.3):232-43.  Back to cited text no. 2
    
3.Winberg J, Bergstrom J, Lincoln K, Lidin Janson G. Treatment trials in urinary tract infection (UTI) with special reference to the effect of antimicrobials on the fecal and periurethral flora. Clin Nephrol 1973;1:142-4.  Back to cited text no. 3
    
4.Edlund C, Nord C. Effect on the human normal microflora of oral antibiotics for treatment of urinary tract infections. J Antimicrob Chemother 2000;46:41-8.  Back to cited text no. 4
    
5.Bhutta ZA. Drug resistant infections in poor countries: A major burden on children. BMJ 2008;336(7650):948-9.  Back to cited text no. 5
    
6.Al-Mardeni RI, Batarseh A, Omaish L, Shraideh M, Batarseh B, Unis N. Empirical treatment for pediatric urinary tract infection and resistance pattern of uropathogens, in Queen Alia hospital and Princess A' Isha military center- Jordan. Saudi J Kidney Dis Transplant 2009;20:135-9.  Back to cited text no. 6
    
7.Younis N, Quol K, Al-Momani T, Al-Awaisheh F, Al-Kayed D. Antibiotic resistance in children with recurrent or complicated urinary tract infection. J Nebal Med Assoc 2009;48:14-9.  Back to cited text no. 7
    
8.Bataineh H, Alrashed K. Resistant gram negative bacilli and antibiotic consumption in zarqa, Jordan. Pak J Med Sci 2007;23:59-63.  Back to cited text no. 8
    
9.Khleifat K, Abboud M, Omar S, Al-Kurishy J. Urinary tract infection in south Jordanian population. J Med Sci 2006;6:5-11.  Back to cited text no. 9
    
10.Baron EJ, Finegold SM, Martin WJ. Organisms encountered in the urinary tract tract. In: Baileys and Scott's (eds.) Diagnostic Microbiology St. Louis CV Mosby 1990;253-63.  Back to cited text no. 10
    
11.Abu Setteh MH. Uropathogens and their susceptibility patterns at King Hussein medical center-Jordan. Gülhane Týp Dergisi 2004;46 (1):10-4.  Back to cited text no. 11
    
12.Abu Shagra Q. Occurrence and antibiotic sensitivity of Enterobacteriaceae isolated from a group of Jordanian patients with community acquired urinary tract infections. Cytobios 2000;101(396):15-21.  Back to cited text no. 12
    
13.Murshidi MS, Farah NB. Urinary tract infections in adult and adolescent males of a developing community: Pattern, bacteriology and genitourinary predisposing factors. Arch Esp Urol 2002;55(10):288.  Back to cited text no. 13
    
14.Orrett FA. Antimicrobial susceptibility patterns of urinary pathogens in Trinidad, 1996 - 1999. J Nation Med Assoc 2003;95:352-62.  Back to cited text no. 14
    
15.Musa-Aisien AS, Ibadin OM, Ukoh G, Akpede GO. Prevalence and antimicrobial sensitivity pattern in urinary tract infection in febrile under-5s at a children's emergency unit in Nigeria. Ann Trop Paediatr 2003;23:39-45.  Back to cited text no. 15
    
16.Rabasa A, Shattima D. Urinary tract infection in severely malnourished children at the University of Maidugiri Teaching Hospital. J Trop Pediatr 2002;48:359-61.  Back to cited text no. 16
    
17.Wammanda R, Ewa B. Urinary tract pathogens and their antimicrobial sensitivity patterns in children. Ann Trop Paediatr 2002;22:197-8.  Back to cited text no. 17
    
18.Al Sweih N, Jamal W, Rotimi V. Spectrum and antibiotic resistance of uropathogens isolated from hospital and community patients with urinary tract infections in two large hospitals in Kuwait. Med Princ Pract 2005;14:401-7.  Back to cited text no. 18
    
19.Orrett FA, Shurland SM. The changing patterns of antimicrobial susceptibility of urinary pathogens in Trinidad. Singapore Med J 1998; 39:256-9.  Back to cited text no. 19
    
20.Karlowsky JA, Jones ME, Thornsberry C, et al. Prevalence of antimicrobial resistance among urinary tract pathogens isolated from female out patients across the US in 1999. Int J Antimicrob Agents 2001;18:121-7.  Back to cited text no. 20
    

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Correspondence Address:
Mohammad Al-Shara
Assistant Professor of Pharmacology, Faculty of Nursing, Irbid National University, Irbid
Jordan
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PMID: 22089796

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