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Abstract：
BACKGROUND: Urinary tract infection (UTI) in children is one of the commonest bacterial infections seen in the pediatric population. Clinical presentation ranges from fever with or without focus and isolation of microbiological agents streamline the treatment. Moreover, local/regional microbial profiles are helpful in antibiotic selection, we conducted a study to assess the prevalence of urine culture positivity in a suspected case of UTI. In addition, antibiotic susceptibility patterns and ultrasonography (USG) finding in culture-positive patients were also studied.
METHODS: It is a prospective observational study comprising symptomatic children aged one month to 18 years presenting to the outpatient department (OPD), inpatient department (IPD), and the emergency department of Pediatrics with UTI during the period of September 2019 to September 2020. The recorded variables were demographic, clinical presentation, anthropometry, physical examination, blood biochemistry, and outcome. Urine samples were collected and processed as per standard protocols. USG was done for all culture-positive children. Data were presented as frequency, mean (SD) and parametric and non-parametric data were analyzed by Wilcoxon-Mann-Whitney U Test, Chi-Squared Test, or Fisher\'s Exact Test. Results: Of the total 354 children, 202 (57.1%) were male and the prevalence of UTI was 64 (18.1%). E. coli (70.3%) was the commonest isolated organism followed by Klebsiella spp (15.6%) and Pseudomonas spp (7%) respectively. The mean (SD) age (months) of presentation of symptoms was significantly lower in culture-positive children as compared to [ 83.49 (58.96) vs 110.10 (58.60); p=0.001] culture-negative children. Fever (96.6%) followed by dysuria (20.1%) were the most common symptoms presented for UTI however dysuria (p=0.003), pus cells (p<0.0001), and RBCs (p=0.002) were significantly present in culture positive children. This study shows increased resistance to third generation of cephalosporins. This study revealed significant differences among various groups (organism growth in positive culture) and the Antibiotic susceptibility test (AST) with a p-value of <0.001. Conclusion: The prevalence of culture-positive UTI was similar to the reported literature and the presence of fever, dysuria, pus cells, and RBC in urine were commonly observed in the lower age group. Amikacin can be used in suspected UTIs with cephalosporin as empirical antibiotics in the Himalayan Foothills region.
METHODS: It is a prospective observational study comprising symptomatic children aged one month to 18 years presenting to the outpatient department (OPD), inpatient department (IPD), and the emergency department of Pediatrics with UTI during the period of September 2019 to September 2020. The recorded variables were demographic, clinical presentation, anthropometry, physical examination, blood biochemistry, and outcome. Urine samples were collected and processed as per standard protocols. USG was done for all culture-positive children. Data were presented as frequency, mean (SD) and parametric and non-parametric data were analyzed by Wilcoxon-Mann-Whitney U Test, Chi-Squared Test, or Fisher\'s Exact Test. Results: Of the total 354 children, 202 (57.1%) were male and the prevalence of UTI was 64 (18.1%). E. coli (70.3%) was the commonest isolated organism followed by Klebsiella spp (15.6%) and Pseudomonas spp (7%) respectively. The mean (SD) age (months) of presentation of symptoms was significantly lower in culture-positive children as compared to [ 83.49 (58.96) vs 110.10 (58.60); p=0.001] culture-negative children. Fever (96.6%) followed by dysuria (20.1%) were the most common symptoms presented for UTI however dysuria (p=0.003), pus cells (p<0.0001), and RBCs (p=0.002) were significantly present in culture positive children. This study shows increased resistance to third generation of cephalosporins. This study revealed significant differences among various groups (organism growth in positive culture) and the Antibiotic susceptibility test (AST) with a p-value of <0.001. Conclusion: The prevalence of culture-positive UTI was similar to the reported literature and the presence of fever, dysuria, pus cells, and RBC in urine were commonly observed in the lower age group. Amikacin can be used in suspected UTIs with cephalosporin as empirical antibiotics in the Himalayan Foothills region.
摘要：
背景：儿童尿路感染（UTI）是儿科人群中最常见的细菌感染之一。临床表现范围从有或没有焦点的发烧和微生物制剂的分离简化治疗。此外，当地/区域微生物谱有助于抗生素选择，我们进行了一项研究,以评估一例疑似UTI病例中尿培养阳性的患病率.此外,还研究了培养阳性患者的抗生素药敏模式和超声检查(USG)发现.
方法：这是一项前瞻性观察性研究，包括1个月至18岁的有症状儿童到门诊部（OPD）就诊，住院部（IPD），以及2019年9月至2020年9月期间使用UTI的儿科急诊科。记录的变量是人口统计，临床表现,人体测量学,体检,血液生物化学,和结果。根据标准方案收集和处理尿样。USG是为所有文化阳性儿童做的。数据以频率表示，均值(SD)以及参数和非参数数据通过Wilcoxon-Mann-WhitneyU检验进行分析，卡方检验,或费舍尔精确检验。结果：在总共354名儿童中，男性202例（57.1%），UTI患病率64例（18.1%）。大肠杆菌（70.3％）是最常见的分离生物，其次是克雷伯菌属（15.6％）和假单胞菌属（7％）。与[83.49（58.96）vs110.10（58.60）；p=0.001]文化阴性儿童相比，文化阳性儿童出现症状的平均（SD）年龄（月）显着降低。尿路感染最常见的症状是发热（96.6%），其次是排尿困难（20.1%）。脓细胞（p<0.0001），和红细胞(p=0.002)在培养阳性儿童中显著存在。这项研究表明，对第三代头孢菌素的耐药性增加。这项研究揭示了不同组（阳性培养物中的生物体生长）和抗生素敏感性试验（AST）之间的显着差异，p值<0.001。结论：文化阳性UTI的患病率与报道的文献相似，并且存在发烧，排尿困难,脓液细胞,尿中红细胞在低龄人群中常见。在喜马拉雅山麓地区，阿米卡星可与头孢菌素作为经验性抗生素一起用于可疑的UTI。
方法：这是一项前瞻性观察性研究，包括1个月至18岁的有症状儿童到门诊部（OPD）就诊，住院部（IPD），以及2019年9月至2020年9月期间使用UTI的儿科急诊科。记录的变量是人口统计，临床表现,人体测量学,体检,血液生物化学,和结果。根据标准方案收集和处理尿样。USG是为所有文化阳性儿童做的。数据以频率表示，均值(SD)以及参数和非参数数据通过Wilcoxon-Mann-WhitneyU检验进行分析，卡方检验,或费舍尔精确检验。结果：在总共354名儿童中，男性202例（57.1%），UTI患病率64例（18.1%）。大肠杆菌（70.3％）是最常见的分离生物，其次是克雷伯菌属（15.6％）和假单胞菌属（7％）。与[83.49（58.96）vs110.10（58.60）；p=0.001]文化阴性儿童相比，文化阳性儿童出现症状的平均（SD）年龄（月）显着降低。尿路感染最常见的症状是发热（96.6%），其次是排尿困难（20.1%）。脓细胞（p<0.0001），和红细胞(p=0.002)在培养阳性儿童中显著存在。这项研究表明，对第三代头孢菌素的耐药性增加。这项研究揭示了不同组（阳性培养物中的生物体生长）和抗生素敏感性试验（AST）之间的显着差异，p值<0.001。结论：文化阳性UTI的患病率与报道的文献相似，并且存在发烧，排尿困难,脓液细胞,尿中红细胞在低龄人群中常见。在喜马拉雅山麓地区，阿米卡星可与头孢菌素作为经验性抗生素一起用于可疑的UTI。
