Urinary Tract Infections in Children

Background and Aim: Urinary tract infection (UTI) causes significant illness in children. The diagnosis in most developing countries is often overlooked due to difficulties in obtaining urine from children especially those who would not void voluntarily. Misdiagnosis often leads to renal damage and hypertension, which could be avoidable with early diagnosis and proper management. Empirical antibiotic treatment in UTI, especially if based on the epidemiology and resistance patterns of common uropathogens, plays an important role in prevention of renal damage. The aim of this study was to evaluate the prevalence of clinical symptoms, laboratory findings, renal ultrasonography, Dimercaptosuccinic acid (DMSA) renal scanning and antimicrobial sensitivity of uropathogens.
Materials and Methods: This retrospective study was conducted on 136 patients hospitalized in Qods hospital of Qazvin with positive urine culture during 2006 (from March through October).
Results: One hundred and thirty five children were included in the study. Of the total, 108 (80%) were females and 27 (20%) were males with a female to male ratio of 5.4:1. The median age of the patients was 24.4 months. Ninety eight (72.6%) patients were from cities and 37 (27.4%) were from rural areas. Of 135 patients, 17 (11.1%) had past history of hospitalization with UTI. Fever was the most common clinical presentation (68.1%) followed by dysuria (37%) and vomiting (29.6%). Normal white blood cell count was found in 113 cases (83.7%) and 22 patients (16.3%) had leukocytosis. Increase  erythrocyte sedimentation rate (ESR) was found in 64 cases (55.6%) and positive C-reactive protein (CRP) in 54.8% of patients. Escherichia coli (E.coli) caused 67.4% of the infections followed by Klebsiella species (14.1%). The majority of the E.coli isolates (90.1%) were from females, while the remaining were from males. Among the gram negative enteric bacilli high prevalence of resistance was observed against ampicillin (86.9%) and co-trimoxazole (78.3%). E.coli isolates had the most sensitivity to amikacin (90.1%), ciprofloxacin (83%), nitrofurantoin (81.2%), ceftriaxon (78.5%), gentamycin (77.8%) and ceftizoxime (74%). Sonography of the kidney and bladder showed abnormality in 15.3% of patients, while the DMSA renal scan was abnormal in 46.5%.
Conclusion: UTI is one of the most common infections diagnosed in hospitalized children, particularly in females. Since in the young children specific clinical signs and symptoms of UTI are uncommon, the presence of other potential signs and symptoms are not reliable in excluding UTI. This study revealed that enterobacteriaceae were the predominant bacterial pathogen of hospitalized children with UTI. It also represents high level resistant of E.coli isolates to ampicillin and cotrimoxazole. Thus, continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence. This study is useful to improve the empiric treatment.