Saudi Journal of Kidney Diseases and Transplantation

: 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

Mohammad Al-Shara 
 Assistant Professor of Pharmacology, Faculty of Nursing, Irbid National University, Irbid, Jordan

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

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;22:1249-1252

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 2020 Dec 5 ];22:1249-1252
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Full Text

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}

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 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.


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