Urinary infections resistant to first-line antibiotics are commonly seen in Tanzanian children with cerebral palsy, an observational study concluded. Researchers say this is alarming and calls for surveillance.

The study, “Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania,” was published in the journal Pediatric Health, Medicine and Therapeutics.

Urinary infections are frequently associated with cerebral palsy. Children with this condition are at a higher risk of developing these types of infections due to a difficulty in controlling their bladder, which causes incomplete emptying and urine retention.

To treat these infections, clinicians often prescribe antibiotics without confirming the presence of the infection or its sensitivity to antibiotics. Treatment with first-line antibiotics can even be obtained over the counter, leading to the overuse of these therapies.

This problem can be particularly serious for children with cerebral palsy who frequently have upper respiratory infections, such as pneumonia, that require antibiotic treatment.

As a result, these children can be at increased risk of developing antibiotic-resistant infections.

Also, inadequate treatment of urinary infections may lead to serious clinical complications, including kidney failure. It also adds unnecessary costs to low-income families, which are common in African countries such as Tanzania.

Researchers conducted an observational, cross-sectional study to quantify the prevalence of urinary infections in Tanzanian children with cerebral palsy.

A total of 99 children between the ages of 3 and 8 were analyzed. The study was conducted at the Conprehensive Community Based Rehabilitation in Tanzania, a healthcare organization, and Moshi and Kilimanjaro Christian Medical Centre in Moshi, Tanzania, from September 2016 to March 2017.

All children who were diagnosed with cerebral palsy and attended the centers were included in the study, regardless of the part of the body affected and the degree of motor impairment.

To confirm the presence of a urinary infection, urine samples were collected from the children, and the causative bacteria were identified in the laboratory. Antibiotic sensitivity testing was also performed using antibiotics recommended by the World Health Organization.

A questionnaire was used to collect demographic and clinical data with the help of parents or caregivers.

Most of the children were boys (58.6%) and most were between the ages of 2 and 4 (53.5). Not many were older than 11 (9.1%).

Thirteen children tested positive for a urinary infection, accounting for 13.1% of all children analyzed.

Infections were caused by five different bacteria species: Escherichia coli, Proteus mirabilis, Klebsiella pneumonia, Staphylococcus aureus, and Enterococcus faecalis.

Researchers found that the two most frequent bacteria found, E. coli and P. mirabilis, were resistant to first-line antibiotics, namely ampicillin and co-trimoxazole.

They were partially sensitive to four other antibiotics (cefotaxime, gentamicin, nitrofurantoin, and amoxicillin-clavulanic acid), and could only be eliminated by ciprofloxacin or ceftriaxone, both generally used for more serious infections.

 Ceftriaxone, for example, is used in hospitals to treat bacterial meningitis.

In addition, no factors (age, sex, fever, motor disability, continence, previous infection, urine colour, or smell) were associated with the presence of urinary infections.

“The observed resistance to first-line antibiotics may be explained by inappropriate use of these antibiotics, that is, either patients use low doses or they do not adhere to the prescriptions, if any are provided,” researchers wrote. 

“This observation is alarming, necessitating a call for local epidemiological surveillance of the antibiotic resistance patterns in our setting,” they added.

These results were similar to studies performed in Turkey, the authors said, but they were different from several other studies, which found a significantly higher prevalence of urinary infections in children with cerebral palsy.

These differences may be due to sample size and the different methods used to collect urine samples, which have higher chances of getting contaminated by bacteria from other tissues.

Also, the authors argue that in the current study, there could have been under-reporting of the use of antibiotics, which could prevent bacteria detection.