86 Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study GK Rai, 1 HC Upreti, 2 SK Rai, 3 KP Shah 1 and RM Shrestha 1 1 Department of Pediatric Medicine, 2 Department of Clinical Pathology, Kanti Children’s Hospital, 3 Shi-Gan Health Foundation, Kathmandu, Nepal Corresponding author: Dr. Ganesh Kumar Rai, MD (Pediatrics), Department of Pediatric Medicine, Kanti Children’s Hospital, Kathmandu, Nepal. e-mail: raiganesh22@hotmail.com ABSTRACT A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children’s Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin. Keywords: UTI, causative agents, antibiogram, children, Nepal. INTRODUCTION Urinary tract infection (UTI) is a common problem in children. 1 The incidence varies according to age, race and sex of children. 2,3 UTI occurs in about 1% of boys and 3-5% of girls. 4 It affects male children more than females in the first year of life and females after 1 year of age. 5 Three to five percent of febrile children are found to have UTI. 6 Symptoms of UTI may be minimal and non-specific in infants and small children. 7 Febrile children not suspected of having UTI are as likely to have UTI as those who are suspected of having UTI. 8 Therefore, diagnosis of UTI can not be made on symptomatology alone and urine examination is advocated in children with minimal suspicion of UTI. 9,10 UTI may lead to life threatening complications like sepsis and renal scaring. Renal scaring is the most common cause of hypertension in later childhood and renal failure in adulthood. 2,7 Recognition of UTI in children should be made as early as possible to prevent these complications. 7 Therefore, investigations for early diagnosis of UTI are of outmost importance. 5 At least 80.0% of UTI in children is caused by Escherichia coli followed by other organisms like Proteus, Enterococcus, Pseudomonas, Klebsiella, Citrobacter and Staphylococcus species. 5 Selection of antibiotics should be based on antibiotic susceptibility pattern. Periodic evaluation of antimicrobial activity of different antibiotics is essential as the pattern of antibiotic sensitivity may vary over short periods. 11 Increasing antibiotic resistance among urinary pathogens, especially E coli, to commonly prescribed drugs like cotrimoxazole has become a global reality. 12 Use of antibiotics by medical practitioners is rampant resulting in increase in resistance to available antibiotics. Isolation of organisms causing UTI and their antibiotic susceptibility is very essential for their appropriate management. 13 The reported positive rate of UTI among Nepalese patients attending general hospitals ranged from 23.1% to 37.4%. 14-16 Urinary tract disorders in Nepal are estimated to be about seven percent and UTI constitutes majority of these disorders. 17 Therefore, this study was conducted to find out the organisms responsible for UTI and their sensitivity pattern in Kanti Children’s Hospital, Kathmandu, Nepal. MATERIALS AND METHODS A retrospective study was conducted to find out the causative agents of urinary tract infections in children and their antibiotic sensitivity pattern among Nepalese children aged less than 15 years. This was done at Kanti Children’s Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests for a period of six months (April to November, 2007). Urine samples collected from children from birth to 14 years of age were included in the study. Clean catch mid- stream urine samples collected into a wide mouthed Original Article Nepal Med Coll J 2008; 10(2): 86-90