1. المضادات الحيوية.....الى أين؟ اليوم العلمي Presented by: Dalia qishawi Trends in Antimicrobial Resistance among Urinary Tract Infection Pathogens Isolated from Children in Gaza, Palestine Abedelraouf A. Elmanama Dalia qishawi Hanan El-Modallal Heba Nofal Mariam Al-khawaja

2. 2 2 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 2 Introduction UTI is a condition where one or more structures in the urinary tract become infected after bacteria overcome its strong natural defenses. UTI is a global costing problem. Almost 95% of UTIs caused by bacterial infection. Children are at high risk of infection.

3. 3 3 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 3 Females are more affected than Males. ( females 8%, males 1-2%) Many risk factors may affect UTI. Complications may occur in UTI leading to kidney scaring. UTI may be due to gram positive or gram negative bacteria, most frequent Uropathogens are Enterobacteriaceae. Introduction (Cont.,)

4. 4 4 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 4 Development of resistance among bacteria become a public concern of modern medicine Resistance is a natural biological phenomenon. Misuse of antibiotic and bacteria itself increase resistance. UTI in Gaza strip is second common infection after respiratory tract. Introduction (Cont.,)

5. 5 5 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 5 Objectives This study was carried to examine the problem extent of children's UTI in Gaza wherein there wasn't any previous studies addressing this issue in children. To Investigate the common bacteria causing UTI and their resistance profiles to antibiotics in order to provide data that may assist in establishing the guidelines for the empirical treatment of UTI. Finally to examine risk factors associated with UTI. This may also provide basics for public health intervention and public awareness programs aiming at reducing the incidence of UTI and antimicrobial resistance.

6. 6 6 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 6 Methodology Between July and September 2006, urine samples were collected from 97 patients children aging from 1 day- 11 years) from El-Nasser hospital) (69 male and 28 female). A questionnaire was collected from patient guardians.

7. %Female%MaleFemaleMaleTotalAge group 6.4%93.6%328311 day-1year 32%67%1225371year-5year 34%65%1019295year-11year Table 1 : Sample population according to sex and age Figure (1): Sex distribution of the study sample

8. Urine NA (>100,000) positive BA Gram positive Enterococcus & Streptococcus Staph S. aureus Coagulase Negative Staph MAC Gram negative API20E identification Catalase _ + Coagulase

9. 9 9 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 9 Antimicrobial susceptibility of bacteria was determined using the disk diffusion method. Gram negative isolates were tested against 8 antimicrobials while gram positive were tested against only 4. Antimicrobial susceptibility

10. 10 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 10 Results and Discussion

11. 11 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 11 Percent % No. of isolate Uropathogens 40%10E. coli 16%4Enterobacter spp 4%1Enterobacter aerogenes 8%2Enterobacter zakazaki 4%1Enterobacter colacae 8%2Klebsilla pneumonia 4%1Serratia liquefaciene 4%1Proteus spp. 4%1Xanthomonas maltophillia 16%4Coagulase Negative Staph 4%1Staphylococcus aureus 4%1Enterococcus spp. 100%25 Total Table: The frequency of uropathogens isolated from urine of children attending Al-Nasser hospital

12. 12 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 12

13. 13 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 13

14. 14 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 14 S %I %R %Antibiotic 15.7%0%84.2% Amikacine 0% 100% Azetreoname 31.5%21%47.3% Ceftazidime 10.5%0%89.4% Nalidixic acid 0% 100% Tetracyclin 10.5% 78.9% Co-trimoxazole 5.2%10.5%84.2% Pipracillin 0%5.2%94.7% amoxicillin Table: The antibiotics susceptibilities for Gram negative bacteria

15. 15 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 15 S %I %R %Antibiotic 0%16.6%83.3% Tetracycline 0%16.6%83.3% Erythromycin 16.6%0%83.3% Vancomycin 0% 100% Amoxicillin Table : The antibiotics susceptibilities percent for Gram positive bacteria

16. 16 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 16 Risk Factor - Prolonged time in going to bathroom and urination. - Delaying exchanging diapers in infant. - Using wipe papers. - Environmental awareness of hygiene and cleanness.

17. 17 اليوم العلمي المضادات الحيوية........ الى أين؟ قسم التحاليل الطبية- الجامعة الاسلامية 17 Conclusions and Recommendations E. coli is the most common causing bacteria of UTI. - Amikacin showed increasing resistance, Ceftazidime is the most effective antibiotic against gram negative isolates. - People should be more careful in using antibiotics. - Doctors should ask for culture before describing antibiotics in non-life threatening infections.