Background

Efforts at effective treatment of urinary tract infection (UTI) have been largely compromised by the evolution and spread of antibiotic resistance in the causative pathogens, leading to restricted therapeutic options. This study aimed to determine the burden of antibiotic drug resistance in UTI among hospitalised paediatric patients in a university teaching hospital in Nigeria.

Methods

It is a descriptive cross-sectional study in which 250 hospitalised paediatric patients with features of UTI were consecutively recruited at UniOsun Teaching Hospital Osogbo from March to September 2022. Appropriately collected urine samples were processed by standard microbiological methods and antibiotic susceptibility tests according to guidelines.

Results

One hundred and sixty-three bacteria were isolated from 250 urine samples, showing a predominance of Gram-negative bacilli (GNB) 137 (82.5%). The common bacterial isolates were Escherichia coli (43, 25.9%), Klebsiella species (23, 13.9%), Proteus species (19, 11.4%), Citrobacter species (16, 9.6%), Enterobacter species (15, 9.0%), and Staphylococcus aureus (15, 9.0%). The uropathogens showed high resistance to first- and second-line antibiotics; GNB particularly showed alarming rates to trimethoprim-sulfamethoxazole (77.0%), gentamicin (51.8%), amoxicillin-clavulanate (47.6%), third- and fourth-generation cephalosporins (39.4–46.8%), and fluoroquinolones (44.5–47.4%). Overall rate of multidrug resistance (MDR) among the pathogens was 54.6%, with common phenotypes being extended-spectrum beta-lactamase-producing GNB (31.4%, 43/137), AmpC beta-lactamase-producing GNB (25.5%, 35/137), carbapenemase-producing GNB (8%, 12/137), and methicillin-resistant Staphylococcus aureus (40%, 6/15).

Conclusion

High rates of antibiotic resistance observed among pathogens of UTI in children highlight a need to curtail inappropriate use of antimicrobials, which is the most important driver of AMR.