RESUMO
Objetivo: Determinar el perfil microbiológico y resistencia antimicrobiana en infección urinaria en niños. Materiales y métodos: Estudio descriptivo, transversal, observacional y multicéntrico. Se estudiaron 445 urocultivos procesados y los resultados de antibiogramas en tres hospitales públicos de Quito (Ecuador). En relación con los agentes causales se establecieron frecuencias absolutas y proporciones. En el análisis bivariable entre el antecedente de malformación renal o de la vía urinaria y el riesgo de infección, se aplicó el test Chi2 (p < 0,05) y la RP [IC 95 %; p < 0,05]. Resultados: Se evidenció una resistencia ante aminopenicilinas del 73,5 %; ampicilina más sulbactam 31,8 %; trimetoprim-sulfametoxazol 55,5 %; cefalosporinas de primera y segunda generación hasta 33 %; cefalosporinas de tercera y cuarta generación del 21,3 al 47 %. Ante malformación urinaria y aislamiento de bacterias diferentes a Escherichia coli, se identificó a Klebsiella pneumoniae RP 2,66 [IC 95 %, 1,9-3,6; p < 0,05] y Pseudomonas aeruginosa RP 2,07 [IC 95 %, 1,2-3,5; p < 0,05]. Conclusiones: En nuestro medio, ante el diagnóstico de infección urinaria, no parece adecuado iniciar tratamiento antibiótico con aminopenicilinas, trimetoprim-sulfametoxazol ni cefalosporinas de primera a cuarta generaciones por su elevada resistencia. La presencia de malformación urinaria se asocia a infección por bacterias diferentes de Escherichia coli.
Objective: Determine the microbiological profile and antimicrobial susceptibility in urinary infection in children. Materials and methods: Descriptive, cross-sectional, observational, and multicenter study. 445 urine cultures and the results of antibiograms were studied in three public hospitals in Quito (Ecuador). In relation to the causal agents, absolute frequencies and proportions were established. In the bivariate analysis, Chi-squared test (p < 0.05) and PR [CI 95 %; p < 0.05] were applied between history of kidney or urinary tract malformation and risk of infection. Results: There was evidence of resistance to aminopenicillins of 73.5 %; ampicillin plus sulbactam 31.8 %; trimethoprim-sulfamethoxazole 55.5 %; first and second generation cephalosporins up to 33 %; resistance to third and fourth generation cephalosporins from 21.3 to 47%. In relation to urinary malformation and the isolate of a bacteria different from Escherichia coli, Klebsiella pneumoniae PR 2,66 [CI 95 %, 1.9-3.6; p < 0.05] and Pseudomonas aeruginosa PR 2.07 [CI 95 %, 1.2-3.5; p < 0.05] were identified. Conclusions: In our locality it wouldn't be appropriate to start antibiotic treatment with aminopenicillins, trimethoprim-sulfamethoxazole or first to fourth generation cephalosporins in urinary tract infection due to their resistance. The presence of urinary malformation is associated with infection by bacteria other than Escherichia coli.
RESUMO
Background: Indiscriminate and inappropriate use of antimicrobial agents (AMA) resulted in rapid emergence of antimicrobial resistance. Institutional level surveillance program to be carried out to track AMA use. The study was conducted to evaluate the prevalence of uropathogens and their susceptibility and resistance pattern in a tertiary care hospital to revise empirical therapy.Methods: Urine samples received from the inpatients and outpatients Departments of Mahatma Gandhi memorial hospital for culture sensitivity between January 2018 to December 2018 were included in this study. Data collected from the Department of Microbiology register by using WHONET software. After identification, isolates were tested for antimicrobial susceptibility by the standard Kirby Bauers diffusion method. Descriptive analysis done and results were expressed as percentage.Results: Out of 3425 samples 68.5% showed no growth, 15.5% normal flora and only 15.9% reported as culture positive. In this study the highest isolate was Escherichia coli (59%) followed by Klebsiella pneumoniae (10.6%), Enterococcus sp. (7%), Staphylococcus aureus (5%), Candid (3.6%), Acinetobactor (3%) and Pseudomonas (2.9%). Uropathogens developed resistance against penicillins, cephalosporins, macrolides and cotrimaxazole.Conclusions: This study confirms, the frequently prescribed empirical therapy drugs were less susceptible and developed resistance than less frequently prescribed and costly drugs. The current antimicrobial resistance pattern alarms the irrational and excessive use of antimicrobial agents. Hence the treating physicians should revise empirical therapy periodically based on the institutional antibiogram and resistance pattern reported from the laboratory to preserve antimicrobial source for the future generation.