DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20182575

The causative microorganisms and the underlying urological anomalies in children with urinary tract infection

Minakshi Bhat

Abstract


Background: Urinary tract infection (UTI) is among the most common bacterial infection in children and may be a presentation of variety of underlying urinary tract abnormalities. It is important to diagnose and treat UTI to prevent the long-term complications like renal scarring, hypertension and chronic renal failure. The aim of this study was to find the causative organism and underlying urological anomalies in children with UTI.

Methods: A prospective study was carried in children (aged between one month to 12 years) admitted with symptomatic UTI in a tertiary hospital from May 2013 to June 2017.The children were investigated for UTI and the urine culture was positive in 121 patients. The confirmed cases of UTI were subjected to imaging studies as per guidelines. Final study included 116 patients as five patients were excluded due to incomplete investigations.

Results: Out of 116 patients, 26 (22.41%) were below 1year ,68 (58.62%) were between 1 to 5 year and 22 (18.96%) were more than 5 years of age. There were 44 (37.93%) males and 72 (62.06%) females. E. coli was the commonest organism causing UTI (78.44%). Urinary tract abnormalities were found in 49 (42.24%) cases. VUR was detected in 23 (46.9%). The other urinary tract abnormalities observed include pelviureteric junction (PUJ) obstruction, posterior urethral valve, urolithiasis, bladder neck obstruction, ureterocele, ectopic kidney, cystic kidney, bladder diverticulum, Extrarenal pelvis, and renal scar respectively.

Conclusions: In view of underlying urological anomalies and potential for renal parenchymal damage, UTI should be diagnosed at an earliest and imaging studies should be done in all confirmed cases as per guidelines.


Keywords


Organism, Urological anomaly, Urinary tract infection, Vesicoureteric reflux

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References


Jones KV, Asscher AV. Urinary tract infection and Vesicoureteral reflux. In: Edelamann CM, Pediatric Kidney Disease, 2nd ed. Boston Little Brown 1992;1943-91.

Rushton HG. Vesicouretral reflux and scarring In: Barratt TM, Avener ED, Harmon WE. Pediatric nephrology, 4th ed, Baltimore, Lippincott william and wilkins 1999;851-71

Riccabona M. Imaging in childhood urinary tract infection. Radiol Med. 2015.

Dick PT, Feldman W. Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr.1996;128:15-22.

Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS. Primary vesico ureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol. 2003;14:739-44.

Jodal U, Hansson S. Urinary tract infection. In: Pediatric Nephrology. Edited by Holliday MA. Barratt TM, Anver ED. Baltimore: Williams and Wilkins;1994:950-962.

Revised Statement on Management of urinary tract infections. The Indian Society of Pediatric Nephrology. Indian Pediatr. 2011;48:709-17.

Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE. International system for radiographic grading of vesicourteric reflux. International reflux study for children. Pediatr Radiol. 1985;15:105.

American Academy of Pediatrics. The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr. 1999;103:843-52.

Ali EM, Osman AH. Acute urinary tract infections in children in Khartoum State: Pathogens, antimicrobial susceptibility and associated risk factors. Arab J Nephrol Transplantat. 2009;2:11-15.

Ahmadzadeh A, Askarpour S. Association of urinary tract abnormalities in children with first urinary tract infection. Pak J Med Sci. 2007; 23(1): 88-91.

Aboud MJ, Kadhim MM.The microorganism and underlying urological anomalies causing the urinary tract infection in the children attended the pediatric surgery clinic at the Maternity and Child Teaching Hospital, AI-Qadisiya,. Iraq. The N Iraqi J Med. 2011;7(2):9-14.

So LY, Davies DP. Urinary tract infection in childhood: a study of 137 cases. HK J Paediatr. 1988;5:17-24.

Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348:195-202.

Downs SM. Technical report:urinary tract infections in febrile infants and young children. Pediatr. 1999;1(103):e54.

Elder JS. Urinary tract infection. Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders Company;2004:621-625.

Waisman Y, Zerem E, Amir L,Mimouni M. The Validity of the uriscreen test for early detection of urinary tract infection in children. Pediatrics. 1999;104(4):p.e41.

Muoneke VU, Ibekwe MU, Ibekwe RC. Childhood Urinary Tract Infection in Abakaliki: etiological organisms and antibiotic sensitivity pattern. Ann Med Health Sci Res. 2012;2(1):29-32.

Biyikli NK, Alpay H, Ozek E, Akman I, Bilgen H. Neonatal urinary tract infections: Analysis of the patients and recurrences. Pedtr Int. 2004;46:21-5.

Arslan S, Caksen H, Rastgeldi L,Uner A, Oner AF, Odabas D. Use of urinary gram stain for the detection of urinary tract infection in childhood. Yale J Biol Med. 2002; 75:73-8.

Falcao MC, Leone CR, D’Andrea RA, Berardi R, Ono NA, Vaz FA. Urinary tract infections in full-term newborn infants: value of urine culture by bag specimen collection. Rev Hosp Clin Fac Med Sao Paulo. 1999;54(3):91-6.

Shah KJ, Robins DG, White RH. Renal scarring and vesicouretesral reflux. Arch Dis Child. 1978;53(3):210-7.

Sciagra R, Materassi M, Rossi V, Ienuso R, Danti A, La Cava G. Alternative approaches to the prognostic stratification of mild to moderate primary vesicoureteral reflux in children. J Urol. 1996;155(6):2052-6.

Stokland E, Hellström M, Jacobsson B, Jodal U, Lundgren P, Sixt R. Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first‐time urinary tract infection. Acta Paediat. 1996;85(4):430-6.

Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatr. 2010;126:1084-91.

Howard RG, Roebuck DJ, Yeung PA, Chan KW, Metreweli C. Vesicoureteric reflux and renal iscarring in Chinese children. Br J Radio. 2001;l74:331-4.