Uropathogens and Their Antimicrobial Resistance Profile at a Pediatric Tertiary Care Hospital in Kathmandu, Nepal

Urinary tract infections (UTIs) are treated based on local antimicrobial susceptibility patterns; however, growing antimicrobial resistance necessitates continuous monitoring. This retrospective study examined the prevalence of pediatric UTIs, identified causative pathogens, and evaluated their antibiograms and resistance patterns. We examined the demographic data, microbiological profiles, and antimicrobial susceptibility results (September 2019-August 2021) of pediatric patients (neonates to 14 years) with positive urine culture results at Kanti Children's Hospital, Kathmandu, Nepal, using SPSS version 17.0 (IBM Corp., Armonk, NY). Among 8,072 urine specimens, 575 (7.1%) (95% CI: 6.6-7.7) tested positive for significant infections, primarily from outpatients (88.2%) and males (54.1%), with a median age of 2 years. Most UTIs (93.0%; 535/575) were caused by bacteria, primarily Escherichia coli (78.5%; 420/535). Cumulative resistance rates were 92.4% for penicillin, 69.3% for cephalosporins, 39.7% for quinolones, 30.2% for carbapenems, and 14.3% for aminoglycosides. One hundred sixty-eight (40.0%) E. coli strains and four (33.3%) Pseudomonas aeruginosa strains were multidrug-resistant. Seven (9.0%) Klebsiella pneumoniae strains were extensively drug-resistant (XDR), and 15 (21.1%) were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant strains (36.5%; 210/575), XDR strains (22.6%; 15/575), and ESBL producers (14.4%; 83/575) showed >70.0% resistance to ampicillin, cefotaxime-clavulanate, and cefixime. Over the years, resistance to β-lactams has risen, whereas resistance to aminoglycosides, carbapenems, and cotrimoxazole has decreased. Resistance to quinolones has remained consistent. Pediatric UTIs were least common in this hospital, with the majority caused by E. coli. Multidrug-resistant bacteria were more prevalent than XDR and ESBL-producing bacteria. Although resistance to β-lactam antibiotics increased over the years, resistance to aminoglycosides, carbapenems, and cotrimoxazole declined.