Bajracharya Sohani, Basnet Ajaya, Pokhrel Nayanum, Gupta Aashish, Khanal Laxmi Kant
Department of Microbiology, Kanti Children's Hospital, Kathmandu, Nepal.
Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
Am J Trop Med Hyg. 2025 Apr 1;112(6):1245-1251. doi: 10.4269/ajtmh.24-0624. Print 2025 Jun 4.
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.
尿路感染（UTIs）的治疗是基于当地的抗菌药物敏感性模式；然而，日益增长的抗菌药物耐药性使得持续监测成为必要。这项回顾性研究调查了儿童尿路感染的患病率，确定了致病病原体，并评估了它们的抗菌谱和耐药模式。我们使用SPSS 17.0版（IBM公司，纽约州阿蒙克）对尼泊尔加德满都坎蒂儿童医院尿液培养结果呈阳性的儿科患者（新生儿至14岁）的人口统计学数据、微生物学特征和抗菌药物敏感性结果（2019年9月至2021年8月）进行了研究。在8072份尿液标本中，575份（7.1%）（95%置信区间：6.6 - 7.7）检测出有显著感染呈阳性，主要来自门诊患者（88.2%）和男性（54.1%），中位年龄为2岁。大多数尿路感染（93.0%；535/575）由细菌引起，主要是大肠埃希菌（78.5%；420/535）。青霉素的累积耐药率为92.4%，头孢菌素为69.3%，喹诺酮类为39.7%，碳青霉烯类为30.2%，氨基糖苷类为14.3%。168株（40.0%）大肠埃希菌菌株和4株（33.3%）铜绿假单胞菌菌株对多种药物耐药。7株（9.0%）肺炎克雷伯菌菌株为广泛耐药（XDR），15株（21.1%）为超广谱β-内酰胺酶（ESBL）产生菌。对多种药物耐药的菌株（36.5%；210/575）、XDR菌株（22.6%；15/575）和ESBL产生菌（14.4%；83/575）对氨苄西林、头孢噻肟 - 克拉维酸和头孢克肟的耐药率均>70.0%。多年来，对β-内酰胺类药物的耐药性有所上升，而对氨基糖苷类、碳青霉烯类和复方新诺明的耐药性有所下降。对喹诺酮类药物的耐药性保持稳定。该医院儿童尿路感染最不常见，大多数由大肠埃希菌引起。对多种药物耐药的细菌比XDR和产ESBL细菌更普遍。尽管多年来对β-内酰胺类抗生素的耐药性增加，但对氨基糖苷类、碳青霉烯类和复方新诺明的耐药性下降。
