INCIDENCE, CAUSATIVE BACTERIA AND ANTI-MICROBIAL SUSCEPTIBILITY OF PEDIATRIC URINARY TRACT INFECTION; A RETROSPECTIVE STUDY IN MOGADISHU, SOMALIA

Abdirahman Abdukadir Ali, Prof. Sun Liang Zhong*, Abdikadar Abdullahi Salad

ABSTRACT

Background- Urinary Tract Infections in children stand out as one of the most common bacterial infections
in pediatrics associated with many complications and morbidities. However, data about these infections among
children in Somalia is limited. Therefore, this study aimed to determine the incidence, etiology, and antimicrobial
susceptibility patterns of the uropathogenic affecting children between 2 months and 15 years of age in a selected
hospital. Objective- To determine the incidence, etiology, and antimicrobial susceptibility patterns of the
uropathogenic affecting children between 2 months and 15 years of age in a selected hospital in Somalia. Methods-
A retrospective study was conducted from January 2022 to December 2023 among children aged 2 months to 15
years old in the department of pediatrics, Somali Sudanese Hospital, Mogadishu, Somalia who had clinical signs
and symptoms of urinary tract infections. One thousand one hundred ninety one (1191) children suspected to have
UTIs based on clinical symptoms had their urine samples examined and cultured onto blood agar and MacConkey
agar plates. The growth of a single organism and more than 10^5 colony-forming units per milliliter (Cfu/mL)
indicated a positive culture. The Kirby-Bauer disk diffusion method was used for the antibiotic susceptibility test.
The positive uropathogen culture incidence rates per 100 children were calculated in stratified age (2 months – 3
years, 4 years – 7 years, and 8 – 15 years). Simple frequency was used to determine proportion and chi-square was
used to determine if there were significant differences between different categories; p values < 0.05 were
considered significant. Results – Twenty-one thousand eight hundred fifty three （21,853 ）children visited the
pediatric department during the study period among which 1191(5.45%) fulfilled the eligibility criteria. Out of
1191 children, 57.2% were female, the majorities (37.0%) of the children were aged 8 – 15 years and 83.5% of the
children were from the Outpatient Department. Urine culture was positive for 273/1191(22.9%) of the clinically
suspected children, the majority of whom (61.5%) were female. The incidence rates were 21.43 per 100 children,
21.82 per 100 children, and 25.17 per 100 children for groups 2 months – 3 years, 4 years – 7 years, and 8 years –
15 years respectively. Five species of bacteria were cultured in the children’s urine (E. coli, Klebsiella species,
Enterobacter species, Proteus species, and Staphylococcus saprophyticus); the most predominant uropathogen was
E.coli at a rate of 50.5%, followed by Klebsiella species (23.1%). The most sensitive antibiotics to the uropathogen
isolated were vancomycin (97.8%), followed by amikacin (89%) and nitrofurantoin (82.4%). The least sensitive
antibiotics were ampicillin (27.5%) and Trimethoprim-sulfamethoxazole (20.7%). Conclusions- The findings
reflect low incidence of urinary tract infections among children less than 15 years of age in this group of children in
Mogadishu Somalia. E. coli is the most predominant uropathogen in children of this age. Vancomycin, amikacin,
and nitrofurantoin are the most sensitive antibiotics to the uropathogen in this group of children under 15 years of
age. Recommendations- basing on these findings, empirical antibiotic selection is guided by local antibiotic
sensitivity data and prevalence of bacterial species based on local data instead of solely relying on global standards
of therapy.

Keywords: Child, Urinary tract infection, Urine culture, Antimicrobial susceptibility.