Urinary tract infection: prevalence pathogens and antimicrobial susceptibility pattern among febrile children at Mwananyamala Hospital Tanzania
Loading...
Date
2013
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Hubert Kairuki Memorial University
Abstract
Background:
Urinary tract infection (UTI) is a common and important cause of morbidity in the
pediatric population in developing countries. Prevalence rates of urinary tract
infection in children range from 3.3% in the United States to 39.7% in
Northwestern Tanzania. Diagnosis of Urinary Tractjnfection in children is
difficult to establish in our setup, therefore in resource-limited settings most
children with Urinary Tract Infection are either misdiagnosed or given empiric
treatment without laboratory confirmation of the infection. Moreover, many
uropathogens are developing resistance to antibiotics recommended by World
health Organization (WHO) to treat urinary tract infection. The magnitude,
etiology and antimicrobial susceptibility of Urinary Tract Infection in Tanzanian
febrile children are not well defined. All published studies to date on the
prevalence and etiology of UTI in febrile children have not included a control
group which is necessary to investigate false positives due to poor collection
procedures or a latent period before the sample is inoculated to the agar growth
media. The urine collected for urinalysis or microscopic needs to be tested as soon
as possible so as to prevent multiplications of organisms. If the urine has to be
cultured, it should be refrigerated during transit and held refrigerated until cultured.
Objective: The objectives of this study was to determine the prevalence of Urinary
Tract Infection, aetiologic pathogens and antimicrobial susceptibility of these
pathogens in febrile children aged two to five (2-5) years in Mwananyamala
District Hospital.
Methodology: This was a Cross-sectional descriptive hospital-based study which
was conducted among febrile children aged two to five years. Febrile and afebrile
children were consecutively recruited from the paediatric and the Reproductive and
vii
Child health (RCH) clinics at Mwananyamala District Hospital. The study was
carried out for six months, i.e. from July to December 2012. Urine was collected
by use of clean catch method into a sterile container. The diagnosis of Urinary
Tract Infection was confumed by bacteriological culture of urine specimen. If
bacterial uropathogens was isolated from the urine specimen, antimicrobial
susceptibility testing was performed using discs for the following antimicrobials:
Cotrimoxazole, Amoxicillin, Erythromycin, Gentamycin, Ceftriaxone,
Ciprofloxacin and Amikacin
Results: A total of 556 children fulfilled the eligibility criteria and were enrolled
into the study. Of these 370 (66.5%) were febrile and 186 (33.5%) were afebrile.
Among the 370 febrile children 29 children were confirmed to have urinary tract
infection by urine culture, giving an overall prevalence rate of 7.8%. Females were
noted to have higher prevalence of UTI than males, however, the difference was
not statistically significant (P^ 0.418). Of the 186 afebrile children 11 were
confirmed by urine culture to have urinary tract infection giving an overall
prevalence rate of 5.9%. Febrile children were noted to have higher prevalence of
urinary tract infection than afebrile children, however the difference was not
statistically significant (P= 0.729). Escherichia coli was the most commonly
isolated organism accounting for 38%, followed by Klebsiella species which
accounted for 21%. Other organisms isolated included Proteus species,
Pseudomonas species and Staphylococcus aureus. Resistance rates of the isolated
uropathogens to, Co-trimoxazole, Erythromycin and Amoxillin were 100%, 89.7%
and 86.2%, respectively. Gentamycin and Ceftriaxone had slightly lower resistance
rates of 48% and 57% respectively while Amikacin and Ciprofloxacin had least
resistance rates of 0% and 6.9%respectively.
Conclusion: Prevalence of Urinary Tract Infection among febrile children aged
two to five (2-5) years attending the Paediatric and the Reproductive and Child
Health Clinics in Mwananyamala District Hospital, Dar es Salaam is 7.8%. The
commonest bacterial Uropathogens isolated fi^om the urine of these children were
Exoli and Klebsiella Species. The isolated bacterial uropathogens showed a
relatively high resistance to Amoxillin, Co-trimoxazole and Erythromycin.
Recommendations: One study conducted at Mwananyamala District Hospital in
children aged 2 to 5 years is not enough to make a recommendation on the
prevalence and pattern of organisms causing Urinary Tract Infection in children
between two and five years in Dar es Salaam. It is proposed that further long term
studies be conducted in order to produce results to advice government to change
the current standard of antibiotic treatment for urinary tract infection.
Description
A dissertation submitted in partial fulfillment of the requirement for the degree of Master of Medicine (Pediatrics and Child Health) of the Hubert Kairuki
Memorial University
Keywords
Antimicrobial, Urinary Tract Infection, Mwananyamala hospital
Citation
Barongo, A. K., 2013. Urinary tract infection: prevalence pathogens and antimicrobial susceptibility pattern among febrile children at Mwananyamala hospital Tanzania. HKMU