Childhood Urinary Tract Infection: Clinical & Laboratory Profile in a Tertiary Care Hospital of Bangladesh

Abstract

Background: Urinary Tract Infection (UTI) implies presence of actively multiplying organisms in the urinary tract. Although it is infrequently associated with mortality, it is still an important cause of morbidity in the paediatric age group. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with UTI. Objective: This study was undertaken to observe the clinical and laboratory profile of UTI in children attending outpatient department (OPD) of Combined Military Hospital (CMH) Dhaka. Methods: This observational cross sectional study was carried out in CMH Dhaka within the period of June 2015 to May 2016. A total of 120 children aged 0 months to 12 years attending paediatric OPD with symptoms of suspected UTI were included in this study. All the children were subjected to do urine analysis including microscopy and culture-sensitivity. Other relevant workups were also done. After enrollment, clinical and laboratory profile were obtained and recorded in case record form. Results: Among 120 patients, 63.3% were females and 36.7% were males. Overall highest number of cases was within the age group of 0 to 5 years (62.5%). The most common clinical presentation was fever (64.2%). Common risk factors were wiping of genital area from back to front (91.7%), irregular antihelminthic intake (70.8%), intake of inadequate drinking water (51.7%), infrequent voiding habit (37.5%) and constipation (32.5%). Patients having previous urethral instrumentation and uncircumcised boys had significantly higher rate of UTI. Among all urine analyses 75% urine samples revealed pyuria. Urine culture was positive in 58 (48.3%) subjects and Escherichia coli (62%) was the commonest isolated organism. The common organisms were highly sensitive to Ciprofloxacin and Levofloxacin. Ultrasonography(USG) of whole abdomen showed abnormal findings in 17.5% cases. High Erythrocyte Sedimentation Rate (ESR) and neutrophilic leukocytosis was evident in 25% cases. Conclusion: This study revealed that UTI was more common in female & under five children. Fever was the commonest symptom and uncircumcised boys had significantly higher rate of UTI. Escherichia coli were the commonest isolated organism but it was resistant to commonly used antibiotics like Amoxycillin and Cephalosporines. In the outdoor set up of CMH Dhaka, Ciprofloxacin and Levofloxacin can be used empirically for UTI treatment after sending urine culture and sensitivity, as most of the organisms are sensitive to these drugs.