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

3. 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.
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4. 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
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5. 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.
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6. 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.
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7. 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.
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8. 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.
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9. 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.
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11. Isolates and their sensitivity patterns
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12. 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.
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13. 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).
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14. 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.
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15. 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.
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16. Thank you.