Etiology and Antimicrobial Susceptibility Pattern of Uropathogens in Children and Adolescents in a Tertiary Hospital: Moving from the Known to the Unknown

Background: Urinary tract infection is a frequent health problem in children and an important cause of morbidity and mortality, with the highest rate seen in the first 2 years of life. Management of a patient with urinary tract infection depends on good knowledge of the causative agents and local antimicrobial susceptibility patterns. This study was designed with the aim to investigate the aetiology and antimicrobial susceptibility pattern of uropathogens in children and adolescents at the University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu. Methods and findings: This was a hospital-based cross-sectional study conducted in Department of Medical Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu. The laboratory records of all the mid-stream urine samples of children and adolescents analysed from 2014 to 2019 were reviewed. Urine sample results from neonates were excluded. Information extracted from the records included: age, sex, date of submission of urine samples, provisional diagnosis, microbial isolates and their susceptibility patterns to various antibiotics. Analysis was done using descriptive and inferential statistics. Of 2199 urine samples that were analysed, 650 (29.9%) yielded significant bacteriuria with females accounting for more than half (363/650: 55.8%) of the cases; (χ2=4.204; P=0.040). Isolated organisms were mostly Gram negative bacilli 33.8%) than males (126/650; 19.4%); (χ2=13.009; p<0.001). The least isolated Gram negative organisms was Pseudomonas aeruginosa seen in 20/650 (3.1%) of the urine samples The Gram positives cocci isolated were Staphylococcus aureus (59/650; 9.1%) and Streptococcus species (12/650; 1.9%). Candida spp was also isolated in 32/650; 4.9% of the urine samples. Most of the isolated organisms showed very high resistance to ampicillin and cotrimoxazole. Moderate resistances were seen with nitrofurantoin, cephalosporins, amoxicillin-clavulanic acid and quinolones. The least resistances were shown with carbapenems piperacillin/ tazobactam, linezolid and cefoxitin. Conclusion: The resistance pattern of organisms causing urinary tract infections in children and adolescents to common antibiotics as highlighted in this study is worrisome. Facility specific guideline for antibiotics therapy is urgently advocated for better management of the patients and to ensure good antibiotics stewardship in line with universally accepted standards.