Antibiotic Susceptibility patterns of culture-positive urine isolates in children under 14 years. Paul Ombuya Laboratory technologist At GCH October 2013.

Introduction Urinary tract infection (UTI) is the second most common infection in the world, with about 8 million visits to clinicians made every year (warren et al 1999). It is caused by viruses, fungi and bacteria. E.coli accounts for 80% of the infections (Bonadio et al., 2001). It is common in all ages and sex with women and children bearing the burden more. Friday, September 14, 2018

Introduction cont’ Treatment of UTI remains a worldwide therapeutic problem (kumar et al., 2006) Use of antibiotics empirically has led to development of resistance by most microorganisms, especially the production of beta lactamase enzymes Friday, September 14, 2018

Problem statement Urinary tract infection affects up to 3.5% of children in United states annually (Freedman A., 2005). Over 150 million people are infected annually costing 6 billion US dollars of global economy, (Gonzalez and Schaeffer, 1999) Use and misuse of antibiotics empirically has led to resistance by most microorganisms. Severe pyelonephritis may cause death. Friday, September 14, 2018

Justification The enzymes are becoming increasingly expressed by many bacteria strains with potential of dissemination. Will help in proper management of uropathogens. Diagnosis of ESBL poses challenges to most microbiology laboratories. Friday, September 14, 2018

Objectives General objective. To determine susceptibility patterns of urine isolates and the proportion of ESBL in children under 14 years attending GCH. Specific Objectives. To determine the proportion of ESBL producers causing UTI in children attending GCH To determine the susceptibility patterns of urine isolates in children seen at GCH. Friday, September 14, 2018

Methodology Study site GCH; 83 bed capacity and approx 600 staff. Study design Retrospective descriptive; Done btw Mar 2010-may 2011. Inclusion criteria: All children taking urine culture test. Friday, September 14, 2018

Methodology Conti’ Sampling method. Purposive, culture positive urine isolates in Vitek data base were analyzed. Data collection methods Desk reviews using vitek specialized tool Data analysis Data was analyzed by Minimum inhibitory concentration. Friday, September 14, 2018

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Isolates and their sensitivity patterns Friday, September 14, 2018

Results 15% of the isolates were ESBL producers Most isolates were sensitive to : ciprofloxacin, gentamicin, ceftazidime norfloxacin,cefodoxime. Augmentin,Nitrofuratoin,ceftriaxone, cefotaxime, Most isolates were resistant to cotrimoxazole. Friday, September 14, 2018

Discussion Beta lactamases are expressed by enterobacteriaceae (Kariuki ., 2001). Formulate a policy of empirical therapy where infections due to resistant organisms are much higher (Mathur et al., 2002). Friday, September 14, 2018

Conclusion There is a high level of ESBL production amongst the urine isolates causing symptomatic UTI in this setup . Empirical treatment should be guided by laboratory evidence for each region. Regular studies should be done to monitor resistance as well as susceptibility patterns. Friday, September 14, 2018

Recommendation Monitor emergence of ESBL by culturing all urines Policy on antibiotic should be available. Regular studies to determine susceptibility patterns. Prospective studies with the corroborations with clinicians would give a better view on the status of this topic. Friday, September 14, 2018

Thank you.