Is Empirical antibiotic treatment in UTI justified in resource constraint settings in India

Abstract

UTI, one of the most common infections noted in children is reported with incidence of 2% in boys and 8% in girls of less than 8year. Absence of specific signs of UTI in younger children and increased risk for complications make it almost mandatory to test for UTI in very young children with fever. Fairly common genitourinary tract abnormalities in young children makes it even more important to screen for UTI as it can lead to chronic kidney injury later. Emperic antibiotic treatment in suspected UTI in children is rampant in our community; equally high is the possibility of antibiotic resistance, which is not studied due to cost limitations. Hence the need for identifying the change in microbial flora causing UTI and their changes in resistance pattern at community level, making it an important tool for preventing and addressing the growth issues,complications like CKD etc. The study aims at addressing this infelt need of the community. Analysis of culture positive UTI cases referred as suspected UTI from the community for evaluation from April 2017-March 2018 were done. Demographic data, organisms, their susceptibility to common antibiotics prescribed in our community settings were analysed. UTI was common in boys between 1-5years. The common organism isolated was E.coli and Enterococcus species followed by Klebsiella in girls and Proteus in males. Nearly 40% of GNB isolates were ESBL producing organisms with E.coli being highest. 70% of E.coli were resistant to commonly used 1stline antibiotics-Ampicillin and cephalexin. 50% of other isolates were resistant to common antibiotics. This may lead to failure of treatment in UTI leading to long-term complications.. Hence empirical antibiotic therapy is not advised even in resource constraint community settings.