Bacterial and Fungal Profile, Antibiotic Susceptibility Patterns of Bacterial Pathogens and Associated Risk Factors of Urinary Tract Infection Among Symptomatic Pediatrics Patients Attending St. Paul’s Hospital Millennium Medical College: A Cross-Sectional Study

Figures & data

Table 1 Socio-Demographic Characteristics of Study Subjects and Frequency of Culture-Positive Samples (N= 227)

Variables	Age in Years	No/Age Group	Culture Positive Sample (%)	Percentage (%)
Age groups	˂ 3	119	35 (29.4)	119 (52.4)
	3–6	31	9 (29.3)	31 (13.7)
	7–9	19	2 (10.50)	19 (8.4)
	10–12	21	2 (9.5)	21 (9.3)
	13–16	37	17 (46.0)	37 (16.3)
Sex	Male	138	30 (33.7)	89 (39.2)
	Female	89	35 (25.4)	138 (60.8)
Residence	Urban	160	41 (25.6)	160 (70.5)
	Rural	67	24 (35.8)	67 (29.5)

Table 2 Prevalence of UTI Based on Patient’s Admission Source and Type of Pathogen

Pathogens		Admission Source
Bacteria	Community-Acquired (<48 hrs)	Ward Acquired	Intensive Care Unit Acquired	Total (%)
Escherichia coli	12	5	4	21 (42.9)
Klebsiella pneumoniae	8	6	3	17 (347)
Enterobacter cloacae	1	0	0	1 (2.0)
Providencia species	0	1	0	1 (2.0)
Acinetobacter species	1	1	2	4 (8.2)
Enterococcus species	2	1	0	3 (6.1)
Coagulase negative staphylococcus species	1	0	0	1 (2.0)
Staphylococcus aureus	0	1	0	1 (2.0)
Bacteria Sub-total	25 (51.0%)	15 (30.6%)	9 (18.4)	49 (100%)
Yeasts
Candida albicans	1	2	3	6 (37.5)
C.tropicalis	0	1	1	2 (12.5)
C. krusei		1	1	2 (12.5)
C. parapsilosis	0	0	1	1 (6.25)
C. lusitaniae	0	0	1	1 (6.25)
C. kefyr	0	0	1	1 (6.25)
C. dubliniensis	0	0	1	1 (6.25)
Cryptococcus neoformans	0	1	1	2 (12.5)
Yeast Sub-total	1 (6.3%)	5 (31.25%)	10 (62.5%)	16 (100%)
Total	26 (40%)	20 (30.8%)	19 (29.2%)	65 (100%)

Table 3 Logistic Regression Analysis of Risk Factors Associated Urinary Tract Infection Among Pediatric Patients at SPHMMC (n = 227)

Characteristics Variables		Positive No (%)	Negative No (%)	COR	95% CI	P-value	AOR	95% CI	P-value
Sex	Male (ref)	35 (25.5)	103 (74.6)				–	–	–
	Female	3 0 (33.7)	59 (66.3)	−1.49	−0.84–2.68	−0.176
Age in years	<3 (ref)	35 (29.4)	84 (70.6)	–	–	–	–	–	–
	3–6	9 (29.0)	22 (71.0)	0.49	0.23–1.04	0.06
	6–9	2 (10.5)	17 (89.5)	0.48	0.17–1.32	0.15
	9–12	2 (9.5)	19 (90.5)	1.06	0.88–1.28	0.517
	12–16	17 (46.0)	20 (54.1)	1.02	0.89–2.89	0.69
Residence	Urban	41 (25.6)	119 (74.4)	1.62	0.88–2.99	0.12	–	–	–
	Rural (ref)	24 (35.8)	43 (64.2)	–	–	–
Circumcision	Yes (ref)	27 (26.0)	77 (74.0)				–	–	–
	No	8 (23.5)	26 (76.5)	1.14	0.46–2.82	0.77
Length of hospital stay	<3 day (ref)	25 (19.4)	104 (80.6)
	3–30 day	37 (42.1)	51 (58.0)	2.12	1.31–3.43	0.002	6.06	1.99–18.4	0.01
	1–2 month	2 (22.2)	7 (77.8)	0.86	0.02–26.2	0.83	–	–	–
	2–3month	1 (100)	0 (0)	1.18	0.57–2.96	0.9	–	–	–
Admission source	OPD (ref)	25 (20.8)	95 (79.2)	–	–	–	–	–	–
	Ward	25 (36.8)	43 (63.2)	0.78	0.26–2.381	0.67
	ICU	10 (52.6)	9 (47.4)	1.33	0.99–1.79	0.055
	Emergency	5 (25.0)	15 (75.0)	3.34	0.86–12.91	0.08
Previous History of UTI	Yes	23 (37.70)	38 (62.3)	1.79	0.96–3.34	0.069
	No (ref)	42 (25.3)	124 (74.7)	–	–	–
Catheterization	Yes	20 (52.6)	18 (47.4)	3.56	1.73–7.3	0.001	0.28	0.13–0.57	0.04
	No (ref)	45 (23.8)	144 (76.2)
HIV status	Positive	5 (62.5)	3 (37.5)	0.66	0.15–2.84	0.575	–	–	–
	Negative (ref)	62 (28.3)	157 (71.7)	–	–	–
Body temperature	<37.5 (ref)	44 (28.2)	112 (71.8)	1.07	0.58–1.98	0.83	–
	>37.5	21 (29.6)	50 (70.4)
Chronic infection	Yes	27 (34.6)	51 (65.4)	1.55	0.85–2.8	0.15	–
	No (ref)	38 (25.5)	111 (74.5)

Table 4 Antimicrobial Susceptibility Pattern of Gram-Negative Bacteria

Isolates	Total		Antimicrobial Agent (%)
			AMP	AUG	AMK	CZ	CIP	NIT	MRP	TZP	SXT
E. coli	21	S	0 (0)	5 (23.8)	20 (95.2)	2 (9.5)	12 (57.1)	15 (71.4)	21 (100)	13 (61.9)	4 (19.1)
		I	0 (0)	2 (9.52)	1 (4.76)	0 (0)	1 (4.76)	1 (4.76)	0 (0)	2 (9.52)	0 (0)
		R	21 (100)	14 (66.6)	0 (0)	19 (90.5)	8 (38.1)	5 (23.8)	0 (0)	6 (28.6)	17 (81.0)
K. pneumoniae	17	S	–	3 (17.6)	15 (88.2)	1 (5.9)	10 (58.8)	5 (29.4)	15 (88.2)	11 (64.7)	2 (11.8)
		I	–	3 (17.7)	0 (0)	0 (0)	1 (5.9)	1 (5.9)	0 (0)	2 (11.8)	0 (0)
		R	–	11 (64.7)	2 (11.8)	16 (94.1)	6 (35.3)	11 (64.7)	2 (11.8)	4 (23.5)	15 (88.2)
Acinetobacter spp	4	S	–	–	4 (100)	–	1 (25)	–	2 (50)	3 (75.0)	1 (25.0)
		I	–	–	0 (0)	–	1 (25.0)	–	0 (0)	0 (0)	0 (0)
		R	–	–	0 (0)	–	2 (50.0)	–	2 (50.0)	1 (25.0)	3 (75.0)
Enterobacter cloacae	1	S	–	–	1 (100)	–	0 (0)	0 (0)	1 (100)	1 (100)	0 (0)
		I	–	–	0 (0)	–	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
		R	–	–	0 (0)	–	1 (100)	1 (100)	0 (0)	0 (0)	1 (100)
Providencia spp	1	S	–	–	1 (100)	–	1 (100)	–	1 (100)	1 (100)	0 (0)
		I	–	–	0 (0)	–	0 (0)	–	0 (0)	0 (0)	0 (0)
		R	–	–	0 (0)	–	0 (0)	–	0 (0)	0 (0)	1 (100)
Total	44	S	0 (0)	8 (21.1)	41 (93.2)	3 (7.9)	24 (54.6)	20 (45.5)	40 (90.9)	29 (65.9)	7 (15.9)
		I	0 (0)	5 (13.1)	1 (2.3)	0 (0)	3 (6.8)	3 (6.8)	0 (0)	4 (9.1)	0 (0)
		R	21 (100)	25 (65.8)	2 (4.6)	35 (92.1)	17 (38.6)	17 (47.7)	4 (9.1)	11 (25.0)	37 (84.1)

Abbreviations: AUG, amoxicillin/clavulanic acid; CIP, ciprofloxacin; NIT, nitrofurantoin; AMP, ampicillin; AMK, amikacin; MRP, meropenem; TZP, piperacillin-tazobactam; CZ, cefazolin; SXT, trimethoprim-sulfamethoxazole; S, susceptible; R, resistant; I, intermediate.

Table 5 Antimicrobial Susceptibility Pattern of Gram-Positive Bacteria

ISOLATE	TOTAL	DSP	Antimicrobial Agent (%)
			PEN	VAN	FOX	CIP	NIT	SXT	DOXY
S. aureus	1	S	0 (0)	0 (0)	1 (100)	1 (100)	1 (100)	0 (0)	0 (0)
		I	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
		R	1 (100)	1 (100)	0 (0)	0 (0)	0 (0)	1 (100)	1 (100)
CONS	1	S	0 (0)	1 (100)	1 (100)	1 (100)	0 (0)	0 (0)	0 (0)
		I	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
		R	1 (100)	0 (0)	0 (0)	0 (0)	1 (100)	1 (100)	1 (100)
Enterococcus spp	3	S	2 (66.7)	2 (66.7)	–	1 (33.3)	0 (0)	–	–
		I	0 (0)	0 (0)	–	0 (0)	0 (0)	–	–
		R	1 (33.3)	1 (33.3)	–	2 (66.7)	3 (100)	–	–
Total	5	S	2 (40.0)	3 (60.0)	2 (100)	3 (60.0)	1 (20.0)	0 (0)	0 (0)
		I	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
		R	3 (60.0)	2 (40.0)	0 (0)	2 (40.0)	4 (80.0)	2 (100)	2 (100)

Abbreviations: CONS, coagulase-negative staphylococci; P, penicillin; FOX, cefoxitin; NIT, nitrofurantoin; doxycycline; VAN, vancomycin; SXT, trimethoprim-sulfamethoxazole; CIP, ciprofloxacin; NT, Not tested; DSP, drug susceptibility profile; S, susceptible; R, resistance, I, intermediate.