Urinary Tract Infection in Omani Children: Etiology and Antimicrobial Resistance. A Comparison between First Episode and Recurrent Infection

Abstract

Aims: The aims of this study were identification of the causative organisms, uropathogens’ resistance, and extended-spectrum β-lactamase producing bacteria in primary and recurrent urinary tract infection. Study Design: A retrospective study included Omani children, less than 14 years, with any documented urinary tract infection. Place and Duration of Study: Sultan Qaboos University Hospital between September 2008 and August 2012. Methodology: Comparison was made between both groups using Chi-squared (χ2) test as appropriate. Results: The first group included 175 children with first attack of urinary tract infection. Escherichia coli was the leading pathogen (69%), Klebsiella pneumonia (17%; P<0.001), and extended-spectrum β-lactamase producing bacteria (3%). 230 isolated uropathogens from 74 patients with recurrent urinary tract infection. The most common isolated pathogen was Escherichia coli 187 (81.3%; P<0.001), followed by Klebsiella pneumonia 12 (5.1%), and extended-spectrum β-lactamase producing bacteria (7%; P=0.042). Overall resistance to parenteral antibiotics was less evident than oral antibiotics, with least resistance to Meropenem and Imipenem (1% each). Higher resistance was found in recurrent urinary tract infection to Augmentin, Cefuroxime, Ceftriaxone, and Cefotaxime. Oral Nitrofurantoin showed least resistance in first and recurrent urinary tract infection, but increased in non- Escherichia coli uropathogens. Conclusion: Escherichia coli and ESBL were more common in recurrent urinary tract infection, while Klebsiella pneumonia were found more in first urinary tract infection. Meropenem, Imipenem, Amikacin, and Piperacillin/Tazobactam can be used cautiously and selectively, while Cefotaxime and Ceftriaxone cannot be used in both groups. Our report shows high resistance rates to Ampicillin, Cefuroxime, and Amoxicillin/Clavulanate. First-generation cephalosporin is not recommended for use as empiric therapy. We recommend the use of Ciprofloxacin and Nitrofurantoin as empiric treatment in both groups, with close monitoring of clinical response. Indeed, a larger scale multicenter national and regional studies are recommended in Oman and gulf region.