PREVALENCE AND ANTIBIOTIC RESISTANCE PATTERNS OF URINARY TRACT INFECTIONS IN NEONATES WITH LATE-ONSET SEPSIS: A CROSS-SECTIONAL STUDY
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Keywords
Late-onset sepsis, Neonatal sepsis, Urinary tract infection, Antibiotic resistance, Escherichia coli.
Abstract
Aim: The aim of the study was to determine the prevalence and trends of antimicrobial sensitivity of urinary tract infections (UTIs) in infants with late-onset sepsis (LOS).
Study Design: This cross-sectional observational study.
Place and Duration: This study was conducted at Institute of Mother & Child Health Nawabshah from July 2024 to July 2025
Methods: Non-probability consecutive sampling of infants with LOS 7-28 days (n=134) was used. Parental consent and LOS criteria were used as inclusion criteria. Exclusions involved congenital anomalies, prior administration of antibiotics or death within the first 24 hours. UTI was then defined as> 10,000 CFU/mL of a single uropathogen in catheterized urine samples. Antimicrobial susceptibility was determined against ampicillin, ceftriaxone, cefotaxime, gentamicin, and amikacin according to the CLSI. Data were processed in SPSS v25 and compared with chi-square tests (p<0.05).
Results: Among 134 neonates (mean age 28.3 ± 5.1 days; 79% male; mean weight 1.92 ± 0.39 kg), E. coli was predominant (64.93%, n=87), followed by Klebsiella (17.91%, n=24), Staphylococci (11.94%, n=16), and Pseudomonas (5.97%, n=8). Staphylococcus showed 66.67% resistance to ampicillin and ceftriaxone and 0% resistance to amikacin. Pseudomonas was ampicillin-resistant, ceftriaxone-resistant, gentamicin-resistant, amikacin-sensitive, and cefotaxime-sensitive (100%). E. coli 92.86% ampicillin resistance, 64.29% gentamicin; Klebsiella 100% ampicillin, amoxicillin, and ceftriaxone. There was no statistically significant difference in the distribution of pathogens based on gender (p=0.389-0.532).
Conclusion: E. coli is the most prevalent pathogen in UTI-related LOS, and it is very resistant to first-line antibiotics. These findings highlight the importance of personalized empiric treatment. Multicenter prospective studies should be considered in the future to quantify long-term outcomes and trends in resistance.
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Zulfiqar Ali Dahri
Consultant pediatrician, Institute of Mother & Child Health Nawabshah Pakistan.
Sheeraz Ahmed
Assistant Professor Pediatric Medicine, Sindh Institute of Child Health Neonatology Sukkur (SICHN) Pakistan.
Fozia Baloch
Associate Professor Pediatric Department, Liaquat University of Medical & Health Sciences Jamshoro Pakistan.
Siraj Nabi Depar
Senior Registrar Pediatric Medicine, People's University of Medical and Health Sciences for Women Nawabshah Pakistan.
Habibullah
Senior Registrar Pediatric Surgery, Sindh Institute of Child Health Neonatology Sukkur (SICHN) Pakistan Pakistan.
Loveena
Senior Registrar Pediatric Medicine, Hamdard University Karachi Pakistan.