using reverse transcription single-round multiplex PCR. J Virol Methods 2003;114:37–44. 9. Kroneman A, Vennema H, Deforche K, et al. An automated genotyping tool for enteroviruses and noroviruses. J Clin Virol 2011;51:121–5. Correspondence: Hiroshi Ushijima, Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 OyaguchiKamicho, Itabashi-ku, Tokyo 173-8610, Japan. E-mail
Changing Profile of Pediatric Community-acquired UTI in a Hospital in South India Knowledge of the changing patterns of uropathogens and their sensitivity to antimicrobials is important in the empiric treatment of urinary tract infection (UTI). We did a retrospective study of UTI-causing organisms and their antimicrobial susceptibility patterns in children aged 1 month to 18 years with culture positive UTI admitted to the Department of Pediatrics, Sri Ramachandra Medical College and Hospital, Chennai, south India between January 2010 and March 2010 and compared it with the corresponding period in 2013. Seven different species of uropathogens were identified from 63 cases in 2010 and 80 cases in 2013. In both groups, Escherichia coli was the commonest pathogen (62.2% in 2010 vs. 54.5% in 2013) followed by Klebsiella species (sp.) (22% in 2010 vs. 14% in 2013) and Proteus sp. (7.9% in 2010 vs. 10% in 2013). Other studies [1–3] have reported similar data. The incidence of Acinetobacter, Pseudomonas and Staphylococcus aureus remained the same in 2010 and 2013. Enterococcus sp. was not isolated in 2010 but was seen in 12.5% in 2013. Enterococcci are one of the ‘ESKAPE pathogens’, as they are capable of escaping the action of antibiotics . Table 1 gives the antimicrobial resistance pattern of gram-negative organisms in the two periods. Out of the seven antimicrobials tested, highest resistance was to ampicillin and cotrimoxazole. There was a
dramatic increase in the extended spectrum beta lactamase (ESBL)-producing organisms from 15% in 2010 to 65% in 2013. Studies from other parts of India also report cephalosporin resistance of 27 to 53% among E.coli [2, 3]. The observed decline in the Imipenam resistance (10% in 2010 vs. 0% in 2013) could be due to strict regulations restricting use of Imipenam, but the number of isolates is too small to draw significant conclusions. To conclude, though E.coli remains the most common pathogen, the incidence of ESBL producers and enterococcal UTI has increased. There is high risk of therapy failure when cephalosporins are used as the first-line antimicrobial. PADMASANI VENKAT RAMANAN, SHALINI SHARMA, and VIDYA KRISHNA Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Pediatrics doi:10.1093/tropej/fmu048 Advance Access Published on 16 September 2014
References 1. Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut City, India. ISRN Microbiol 2013;29:749629. 2. Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 2007;6:4. 3. Eshwarappa M, Dosegowda R, Aprameya IV, et al. Clinico-microbiological profile of urinary tract infection in South India. India J Nephrol 2011;21:30–6. 4. Infectious Diseases Society of America (IDSA), Spellberg B, Blaser M, Guidos RJ, et al. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis 2011;52(Suppl 5):S397-428. Correspondence: Padmasani Venkat Ramanan, Prof. and HOD, Dept. of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai 600116. E-mail .
TABLE 1 Antimicrobial resistance pattern of gram-negative uropathogens in 2010 and 2013 Antibiotic