ABSTRACT:Urinary tract infection (UTI) is a common infection in infants and children. The clinical manifestations of UTI are varied and the etiology of UTI and the antibiotic resistance of uropathogens have been changing over the past years, both in community and nosocomial infections. However, there are not much information on etiology and resistance pattern of community acquired UTIs in India. This study was designed and conducted in the department of Pediatrics, BVDU Medical college hospital, Pune during the period from July 2009 to August 2011 to study children from birth to 12 years of age presenting with their first UTI with respect to their age and sex distributions, clinical manifestations, laboratory parameters, uropathogens and their antibiotic sensitivity patterns of 52 patients who attended our tertiary care centre. This study showed highest incidence of first UTI among infants with male preponderance among <2 years of age. The commonest risk factor for UTI was identified as obstructive uropathy, followed by VUR. The commonest symptom of UTI was found to be fever followed by dysuria and pain abdomen. The commonest sign was pyrexia. On urinalysis most patients had significant pyuria (>5WBCs/mm 3 ). E. coli was the commonest organism found in urine culture in all the age groups followed by CONS, Klebsiella and Pseudomonas. Maximum Sensitivity of E. coli was to Imipenem, Meropenem, Amikacin, Gatifloxacin and Nitrofurantoin. E. coli was found resistant to commonly used oral antibiotics like cotrimoxazole, ampicillin, cephalexin, cefuroxime, cefixime, cepodoxim. Most isolates of Klebsiella, Pseudomonas and Proteus were highly sensitive to PiperacillinTazobactum, Imipenem, Aminoglycosides, Fluroquinolones and Nitrofurantoin. Also, Klebsiella isolates were found sensitive to third generation cephalosporins but Pseudomonas and Proteus isolates were resistant to it. CONS and Enterococci were highly sensitive to Co-amoxyclav, Ampicillinsulbactum, Piperacillin-tazobactum, Imipenem, Amikacin and Gatifloxacin. KEYWORDS: UTI, Uropathogens, Antibiotic Sensitivity and Resistance. INTRODUCTION:Urinary tract infection (UTI) is a common infection in infants and children. The risk of developing urinary tract infection (UTI) before the age of 14 years is approximately 1% in boys and 3-5% in girls. The incidence varies with age, being highest in the first year of life for all children (1%) but decreases substantially among boys after infancy. (1,2) Screening studies in emergency departments suggest that upto 5% of children under the age of 2 presenting with fever have urinary tract infection (UTI), and over half of these would have been given alternative diagnoses such as otitis media had the urine not been screened as part of the study. (3,4) During the first year of life, the male to female ratio is 3-5:1. Beyond 1-2 years, there is female preponderance with male to female ratio of 1:10. (5,6) The diagnosis of urinary tract infection (UTI) is often clinically missed in young children, as symptoms are minimal and often n...
BACKGROUNDBlunt abdominal trauma usually has low sensitivity on physical examination and also subtle clinical manifestations. Improved resolution of the ultrasound machines and availability of multiple frequency probes has improved the specificity of ultrasound evaluation in blunt abdominal trauma. Despite this about 50% of the solid organ injuries are missed. Computed tomography has been used with better specificity to evaluate patients with blunt abdominal trauma who are FAST (Focused Assessment with Sonography for Trauma) positive as well as indeterminate and clinically suspicious cases of solid organ, hollow viscera, spine and pelvic injury.
ABSTRACT:Imaging of the urinary tract is recommended for all children with UTI. The aim of these investigations is to identify patients at risk of renal damage, mainly those below 5years of age, with vesicoureteric reflux (VUR) or urinary tract obstruction. This study was designed and conducted in the department of Pediatrics and department of Radiodiagnosis, BVDU Medical college hospital, Pune during the period from July 2009 to August 2011 to do imaging studies as per protocol of investigations suggested by the Indian Pediatric Nephrology Group of children from birth to 12 years of age presenting with their first culture positive UTI who attended our tertiary care centre. Abnormal USG was found in 40.3% cases and helped to identify hydroureteronephrosis (HUN) and calculi. Micturating cystourethrography (MCU) examination was abnormal in 31.1% cases. Of which, 22.2% patients had VUR suggesting that VUR is common in culture positive UTI, thus stressing the need of MCU in patients of culture positive UTI. DMSA scintigraphy (DMSA) showed scar in 56% of total cases examined indicating need for doing DMSA whenever indicated and for prognostication. One single imaging modality is not sufficient to evaluate children with UTI. HOW TO CITE THIS ARTICLE: INDRODUCTION: Urinary tract infection (UTI) is a commoninfection in infants and children. Rapid evaluation and treatment of UTI is important to prevent renal parenchymal damage (Renal scarring) that can cause hypertension, toxaemia of pregnancy, chronic renal failure and end-stagerenal disease later. Risk factors for renal scarring include: young age especially children less than one year old, delay in initiating antibacterial treatment, recurrent UTI, and presence of moderate to severe VUR. (1,2) Imaging of the urinary tract is recommended for all children with UTI. The aim of these investigations is to identify patients at risk of renal damage, mainly those below 5years of age, with VUR or urinary tract obstruction. The following is the protocol of investigations suggested by the Indian Pediatric Nephrology Group in the consensus statement on management of urinary tract infection. (2) 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. In addition, a micturating cystourethrography (MCU) is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done. (3,4,5) In one study VUR was identified in 106 of 171 kidney units when MCU was done following the first UTI. (6) DMSA renal scan is the best mode for evaluation of renal parenchymal involvement. During the acute infection it can detect focal pyelonephritis and later show renal scars.
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