Prevalence, bacterial causes and antibiotoc sensitivity of urinary tract infections in children presenting with fever to acute care unit in mulago hospital.

Abstract

INTRODUCTION AND BACKGROUND: Urinary tract infection (UTI) is a problem that is frequently encountered by pediatric health care providers. The role of UTI as an occult cause of febrile illness in young children has been recognized over centuries. The prevalence, causative organisms and sensitivity patterns of UTI among children presenting to emergency units have been shown to vary from place to place and there is documented increasing resistance to commonly used antibiotics. OBJECTIVES: To determine the prevalence, bacterial causes and antibiotic sensitity of urinary tract infections in children 2 months to 12 years who presented with fever to Acute care unit in Mulago hospital, kampala, Uganda. METHODS: This was a descriptive cross sectional study carried out from February to march 2007 in the acute care unit of Mulago hospital. Children with a history of fever were recruited into the study by consecutive enrolment. They were assessed for symptoms of urinary tract infections and some factors associated with urinary tract infections in the history. A complete physical examination was done. Blood was taken for HIV testing for all the children. Urine was collected from every child. Dipstick urinalysis, microscopy and culture were done on all the samples collected. The main outcome measures were the proportion of cultures with significant bacterial growth (104 for catheter specimens and 105 for midstream urine), the causative bacteria and their antibiotic sensitivity patterns. DATA MANAGEMENT: The different variables were recorded into a structured questionnaire and then entered into a computer using Epidata and analyzed using SPSS 11 software. RESULTS: 486 children aged 2 months to twelve years presenting with fever to acute care unit were recruited between February 2007 and March 2007. Of the 486 children studied, 71(14.6%) had significant bacterial growth on urine culture. The predominant organism was Escherichia coli (45%) followed by klebsiella species (17%). Among the gram positive organisms, staphylococcus species was the most common (8%) followed by Enterococcus (5%). Most of the gram negative organisms (up to 73.1%) were sensitive to Nalidixic acid, cefuroxime (73.8%), nitrofurantoin (69.7%), cetriaxone (93.2%) and ciprofloxacin (73.8%). There was notable resistance to gentamicin (33.8%). O fht egram negative organisms, 91.2% and 92.4% were resistant to ampicillin and co-trimoxazole respectively. Factors significantly associated with urinary tract infection were diarrhoea, pre-hospital medication abd age less than 2 years with p values= 0.014, 0.024 and 0.005 respectively. CONCLUSION: The prevalence of urinary tract infection among children 2 months to twelve years presenting with fever to acute cate unit was 14.6%. The most common organism isolated was Escherichai coli. RECOMMENDATIONS: This study recommends that all children of age less than 2 years presenting with fever to the ACU should be screened for UTI. Uirne culture and sensitivity should be done when urinary tract infection is strongly suspected. Nalidixic acid, cefuroxime or nitrofurantoin would be appropriate as first line drugs for the initial empirical treatment of children with suspected urinary tract infection.