DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20193101

Prevalence of urinary tract infection in malnourished children aged 6 months to 5 years attending tertiary care centre

Senthil Kumar A., Thannoli Gowthami Gowrinathan

Abstract


Background: Infections are more common in malnourished children, as result of impaired immunity. Unexplained fever and failure to thrive are the common presenting features of urinary tract infection (UTI) in children. In malnourished children, UTI is mostly asymptomatic and is leading to pyelonephritis and renal scarring. The study was done with the aim to evaluate and find out the prevalence of urinary tract infection in malnourished children between 6 months to 5 year and to find out the causative organism and antibiotic sensitivity pattern.

Methods: A total of 180 cases of malnourished children were enrolled and clean catch midstream urine sample was collected for urine culture, according to WHO criteria of malnutrition. Children with urinary tract abnormality were excluded from the study. Renal USG was done in all urine culture positive cases.

Results: Total of 174 cases was present after exclusion. Of 174 children, 27 (15.5%) children were having UTI. In this study, 37% of children are asymptomatic. E. coli is the commonest organism causing UTI 16 (59%). Other organism are Klebsiella pneumonia 4 (14.9%), Proteus mirabilis 3 (11.1%), and Pseudomonas 3 (11.1%). The order of antimicrobial sensitivity pattern was amikacin (100%)> ciprofloxacin (81.4%)> cefotaxime (7%). Other common drugs have developed resistance to these organisms.

Conclusions: Our observations conclude that malnourished children with fever of unknown origin are at risk of UTI. Hence, urine analysis and culture tests are to be done to all malnutrition cases for assisting to diagnose the bacterial infection and providing the appropriate treatment.


Keywords


Antibiotic spectrum, Malnutrition, Urinary tract infection

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References


Robinson JL, Finlay JC, Lang ME, Bortolussi R. Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee. Paediatr Child Health. 2014;19(6):315-25.

Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics. 1998;102(2):16.

Uwaezuoke SN. The prevalence of urinary tract infection in children with severe acute malnutrition: a narrative review. Pediatric Health Med Ther. 2016;7:121-7.

Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN, et al. Bacteriuria and urinary tract infections in malnourished children. Pediatr Nephrol. 2003;18(4):366-70.

Rabasa AI, Shattima D. Urinary tract infection in severely malnourished children at the University of Maiduguri Teaching Hospital. J Trop Pediatr. 2002;48(6):359-61.

Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: A meta-analysis. Pediatr Infect Dis J. 2008;27(4):302-8.

Robino L, Scavone P, Araujo L, Algorta G, Zunino P, Pírez MC, et al. Intracellular bacteria in the pathogenesis of Escherichia coli urinary tract infection in children. Clin Infect Dis. 2014;59(11):158-64.

Caksen H, Cesur Y, Üner A, Arslan S, Sar S, Celebi V, et al. Urinary tract infection and antibiotic susceptibility in malnourished children. Int J Urol Nephrol. 2000;32(2):245-7.

National Institute for Health and Clinical Excellence. Urinary Tract Infection in Children. NICE Clinical Guideline 54. London: NICE; 2007.

Page AL, de Rekeneire N, Sayadi S, Aberrane S, Janssens AC, Rieux C, et al. Infections in children admitted with complicated severe acute malnutrition in Niger. PloS one. 2013;8(7):e68699.

Berkowitz FE. Infections in children with severe protein-energy malnutrition. Ann Trop Paediatr. 1983;3(2):79-83.

Thuo N, Ohuma E, Karisa J, Talbert A, Berkley JA, Maitland K. The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. Arch Dis Child. 2010;95(6):422-6.