Details
Category: Volume 06 Issue 12 December 2018
Hits: 1004

Title: Clinical, Bacteriological Profile and Management Practices in Culture Positive Urinary Tract Infection in Children

Authors: Sharon Victoria Mendez, Jaidev M.D, Pavan Hegde, Habeeb Ullah Khan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i12.103

Abstract

Introduction: Urinary tract infection (UTI) is seen in approximately 3-5% of girls and 1 % of boys. UTI can be the first presentation in 30% of children with urinary tract anomalies. Failure to identify these patients can result in damage to upper urinary tract and long term sequelae like renal scaring and hypertension.

Materials and Methods: Retrospective, time-bound case notes review  over a period of one year of children with culture positive UTI admitted in Father Muller medical college hospital. Patient information was collected in a pre-structured and pre-validated proforma from case records. Mean, frequency, percentage, standard deviation were calculated for all descriptive data while continuous data was analysed using student’s t-test. P-value <0.05 was considered significant.

Results: A total of 40 children were included in the study. Majority of study subjects were females in the age group of 1-5 years (60%). Most common symptoms reported in children <5 years was fever (58%) and excessive cry while passing urine (58%) whereas 50% of children >5 years had complaints of pain abdomen. Previous history of UTI was present in 22% of subjects. Urine analysis had a sensitivity of 75% and specificity of 67%.The organism predominantly causing UTI continues to be E. coli (67%). Multidrug resistance was noted in 52.5% of isolates. In children less than 5 years, 88% of USGs were abnormal. All abnormal MCUs were in children below 5 years of age. Dimercaptosuccinic acid (DMSA) scan was abnormal in 50% of children in whom it was performed.

Conclusion: UTI in children presents with a wide variety of non-specific symptoms. UTI can be the first presentation of a child with genitourinary abnormalities. Urine microscopy can be used as a screening test in UTI. Abnormal USG and MCU studies are commonly seen in children less than 5 years with culture positive UTI hence imaging studies are warranted. There is increasing incidence of multidrug resistant strains causing UTI.

Keywords: UTI, Urine culture, Urine analysis, Genitourinary abnormalities, Imaging studies

References

  1. Vijayakumar M, Kanitkar M, Nammalwar BR, Bagga A. Revised Statement on Management of Urinary Tract Infections, Indian Society of Pediatric Nephrology. Indian Pediatr.2011; 48:709-17.
  2. Stein R, Dogan HS, Hoebeke P, Kocvara R, Nijman RJ, Radmayr C, Tekgul S. Urinary tract infections in children: EAU/ ESPU guidelines. Eur Urol. 2015; 1 (67): 546.
  3. National Collaborating Centre for Women's and Children's Health (UK). Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management. London: RCOG Press; 2007. (NICE Clinical Guidelines, No. 54.)
  4. Simões e Silva AC, Oliveira EA. Update on the approach of urinary tract infection in childhood. J Pediatr. 2015; 91: 2-10.
  5. Elder JS. Urinary Tract Infections. In: Kliegman RM. Nelson Textbook of Pediatrics. 20th edition. Philadelphia: Elsevier; 2016; 2556-61
  6. Bitsori M, Galanakis E. Pediatric urinary tract infections: diagnosis and treatment. Expert Rev Anti Infect Ther. 2012; 10(10):1153-1164.
  7. Tanaka ST, Brock JW. Pediatric urologic conditions, including urinary infections. Med Clin North Am. 2011; 95(1):1–13.
  8. Bhat RG, Katy TA, Place FC. Pediatric urinary tract infections. Emerg Med Clin North Am. 2011;29(3):637–653.
  9. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011; 128(3):595-610.
  10. Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, Watt I, Glanville J, Sculpher M, Kleijnen J. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model. Health Technol Assess. 2006;10(36).
  11. Spahiu L, Hasbahta V. Most frequent causes of urinary tract infections in children. Med Arh.2010;64:88–90
  12. Gaspari R, Dickson E, Karlowsky J, Doern G. Multidrug Resistance in Pediatric Urinary Tract Infections. Microb Drug Resist.2006;12(2):126-129.
  13. Luk W, Woo Y, Au-Yeung A, Chan J. Imaging in Pediatric Urinary Tract Infection: A 9-Year Local Experience. Am J Roentgenol. 2009;192(5):1253-1260.

Corresponding Author

Sharon Victoria Mendez