A retrospective study on antimicrobial resistance pattern of uropathogenic E. coli in rural paediatric population attending tertiary care centre in Tamil Nadu

Urinary tract infections are one of the commonest infections occurring in pediatric population. The diagnosis of UTI is difficult due to lack of proper history and absence of typical clinical symptoms as in the adult population. The most common reasons for development of UTI are the anatomical proximity in female and surface area of the prepuce in male uncircumcised children. The most common bacteria associated with infections are , , , , & . Among the gram-positive organisms, , , , & have been documented to cause infections. : Urine samples processed for culture and sensitivity, from January 2021 to December 2023 from patients ranging from zero days to 18 years were included in the study. Repeat urine samples were excluded from the study. Sample showing no growth or insignificant growth or more than two types of bacterial colonies were excluded from the study. All samples of patients above the age of 18 years were also excluded. Those samples which fit the inclusion criteria were tabulated according to age, gender, bacterial species and antimicrobial resistance. The above data was collected using the ERP software Sage 300. The samples were divided based on the age group of the patients into four groups comprising of Group I: 0 days to 2 years, Group II: 2 to 5years, Group III – 6 to11 years & Group IV: 12 to 18 years. The study revealed a significant prevalence of urinary tract infections (UTIs) in the pediatric population, with being the primary causative agent. The highest incidence was observed in the 0-2 age group, with a notable decline in infections in male children as they aged. Female children, however, exhibited a more persistent infection rate across different age groups. Alarmingly, increasing antibiotic resistance was observed, particularly against ampicillin, cephalosporins, and fluoroquinolones. In contrast, aminoglycosides, carbapenems, nitrofurantoin, and fosfomycin demonstrated higher sensitivity rates, highlighting their potential as effective treatment options. There needs to be a separate antibiotic policy for paediatric patients according to the age group and gender so that age & gender-based antibiotics can be selected for empirical therapy. This will in turn lead to a better antibiotic usage which will be cost effective as well as handle the emerging drug resistant organisms of the Enterobacteriaceae family.