Clinical and Laboratory Profile of Children Birth to 12 Years Presenting With First Urinary Tract Infection (Uti) at a Tertiary Care Hospital

Abstract

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...