BackgroundUrinary tract infection (UTI) is usually defined as the presence of actively multiplying organisms in any part of the urinary tract such as kidneys, bladder, and urethra (1,2). Bacterial agents are mainly implicated as the causative germs of UTIs (3,4) which account for more than 95% of all cases (5). Viruses, parasites, and fungi may also be responsible for this type of infection, especially in immuno-compromised individuals (1,3). Each year, about 150 million urinary infection cases are recorded worldwide costing the world economy over six billion US dollars (5,6). According to some reports, several factors such as age, gender, race, and circumcision status are associated with an increased risk of UTI (1). The bulk of UTIinduced burden is concentrated on children, pregnant women, child-bearing women, and immunocompromised individuals (1,3).Similarly, evidence-based information regarding the epidemiology of UTIs is increasingly released but disseminated in the African continent. However, the existing studies evaluating the prevalence of UTI causative germs emphasized the significant predominance of Gram-negative bacteria with Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae as the most prevalent germs (7-10).Young children represent one of the most social groups who are at the risk of UTI (1,3) which is a common and important public health problem since its symptoms in children may be subtle or non-specific making the diagnosis more complicated (11,12). In general, the symptoms in children may include fever, vomiting, diarrhoea, poor appetite, irritability, and the overall feeling of illness (4). When UTI is not early diagnosed, life-threatening complications such as sepsis and renal scarring may occur as a consequence. In addition, renal scarring is the most common cause of hypertension in later childhood and renal failure in adulthood (3,7,12).In developing countries particularly in resourceconstrained ones, the treatment of UTI heavily relies on an empiric or probabilistic approach (2,7,12) which owing to various reasons, may be initiated even before the availability of the final laboratory diagnostic test results (6). Accordingly, this increases the drug pressure which the uropathogens are exposed to and thus leads to the
Objective: Urinary tract infection (UTIs) in child is a serious public health problem especially in developing countries. This study aimed at identifying factors associated with urinary tract infection and determining their diagnosis performances as well as resulting algorithms among Cameroonian under-five. Methods: A descriptive and analytical cross sectional study took place from May 2013 to March 2014 at Pediatrics Department of the Bonassama District hospital in the town of Douala. Urine samples were collected dependent on the age of children and its aptitude to micturate. Ten microliters (10 µL) of urine specimen were cultured at 37°C for 24-48 hours. In addition, sociodemographic, anthropometric, clinic and biological information of each child were documented. Results: The prevalence of UTI was 32.2% (129/400) which was mainly caused by Escherichia coli (41.1%). A total of four risk factors for UTI were found after adjustment for all pertinent characteristics of children. These included female gender (ARR= 0.55; p= 0.0046), presence of fever (ARR = 1.83; p= 0.0426), trouble urine (ARR = 1.36; p= 0.0063) and presence of nitrites in urine (ARR = 1.09; p= 0.0001). Presence of nitrites was the most discriminant parameter based on specificity (98.1%), positive predictive value (95.4%) and negative predictive value (90.1%). The diagnosis performances have gradually improved with the increasing number of parameters. Conclusion: This study reported four factors associated with increased risk for UTI. This also outlined that the presence of nitrites in urine had best diagnosis performances and different predictors-based clinical algorithms could be helpful especially in the identification of UTI-negative children.
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