Multidrug-Resistant Urinary Tract Infection in Children: Experience from a Semi Urban Community of Bangladesh

Abstract Background: The growing prevalence of antimicrobial resistance in pediatric urinary tract infection (UTI) which results in the inefficacy of first-line antibiotics and complicates the management is a burning issue. This study has explored the causative pathogens, risk factors, and antimicrobial resistance patterns of multidrug resistance (MDR) UTI in a specified population. Materials and Methods: This descriptive observational study included suspected UTI from 1 month to 18 years of age. Culture, sensitivity, and colony count from midstream urine were performed. Results of urine culture and antibiotic susceptibility of the isolated pathogens were recorded. Results: The majority (72.3%) of culture-positive UTI cases were diagnosed as MDR UTI. Most of the patients (44.7%) were within 1–5 years of the age range. There were more female patients (55.3%) than males. Fever was the presenting complaint in 78.7% of patients, followed by urinary symptoms in 23.4% cases. Risk factors were as follows: female gender, uncircumcised male, poor perineal hygiene and others. Gram-negative bacteria constituted the highest number (91.5%) of bacterial infections, and among them Escherichia coli was the most common (65.9%), followed by Klebsiella (14.9%). E. coli had a very high resistance pattern to all the groups of antibiotics, including the following: beta lactams, quinolones, sulfonamides, aminoglycosides, nitrofurantoin, and carbapenem. Amoxicillin from the beta lactam group showed the highest resistance to E. coli (93.5%) and lowest resistance was by aztreonam (22.6%) from the same group. Conclusion: A high prevalence of MDR UTI was found in this study. Female gender, un-circumscribed male, non-maternal caregivers, and poor hygiene were significant risk factors. E. coli was found as the most common organism, and most of them were resistant to common antibiotics for UTI.