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Abstract：
Introduction Individuals with sickle cell disease (SCD) are particularly vulnerable to urinary tract infections (UTIs) due to immunological deficits and renal abnormalities associated with the disorder. These infections can exacerbate underlying health issues and lead to severe complications if not managed promptly and effectively. Due to the heightened risk and potential consequences of UTIs in this population, this study aimed to determine their prevalence and explore the resistance patterns of causative pathogens among children attending the SCD Clinic at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Focusing on this demographic group, we sought to provide targeted insights to inform better clinical protocols and intervention strategies in regions heavily affected by SCD. Materials and methods This prospective cross-sectional study was conducted at the MNH, Dar es Salaam, Tanzania, with an enrollment over two months from 19th March to 21st May 2015. We diagnosed UTIs in children with SCD using dipstick and culture methods. Antibiotic susceptibility was assessed using the Kirby-Bauer disc diffusion method, evaluating resistance patterns to antibiotics such as ampicillin, cloxacillin, erythromycin, chloramphenicol, ceftriaxone, and trimethoprim-sulfamethoxazole. The diagnostic accuracy of the dipstick and culture methods was validated to ensure reliability in detecting UTIs. Statistical analysis was conducted using Statistical Product and Service Solutions (SPSS) software (Released 2019; IBM Corp., Armonk, New York, United States). Results Among the 250 children, 56 (22.4%) were UTI-positive according to the culture method and 62 (24.8%) were UTI-positive according to the dipstick test. Girls were more likely to be UTI-positive than boys (29.1% and 13.6%, respectively; p-value = 0.011). Escherichia coli was the most common uropathogen, followed by Klebsiella, Staphylococcus, Proteus, and Pseudomonas (44.2%, 26.9%, 21.2%, 3.8%, and 1.9%, respectively). All isolates were resistant to ampiclox. Resistance rates to ampicillin, erythromycin, cotrimoxazole, chloramphenicol, and ceftriaxone were 94.2%, 76.9%, 59.6%, 46.2%, and 21.2%, respectively. Conclusion This study indicated that dipsticks diagnosed more UTIs. The prevalence was higher in girls than in boys. Escherichia coli was the most commonly isolated antibiotic-resistant organism. High resistance levels were observed against the combination of ampicillin and cloxacillin. However, the isolates were less resistant to ceftriaxone. These results call for increased surveillance of resistant uropathogens in the pediatric population with SCD.
摘要：
背景技术患有镰状细胞病(SCD)的个体由于与疾病相关的免疫缺陷和肾脏异常而特别容易受到尿路感染(UTI)的影响。这些感染会加剧潜在的健康问题，并导致严重的并发症，如果不及时和有效地管理。由于UTI在该人群中的风险和潜在后果增加，这项研究旨在确定其患病率，并探讨在Muhimbili国立医院（MNH）SCD诊所就诊的儿童中病原体的耐药模式，达累斯萨拉姆,坦桑尼亚。关注这个人口群体，我们试图提供有针对性的见解,以便在受SCD影响严重的地区提供更好的临床方案和干预策略.材料和方法这项前瞻性横断面研究是在MNH进行的，达累斯萨拉姆,坦桑尼亚,从2015年3月19日至5月21日两个月的注册。我们使用试纸和培养方法诊断SCD儿童的UTI。使用Kirby-Bauer椎间盘扩散法评估抗生素敏感性，评估对氨苄青霉素等抗生素的耐药模式，氯唑西林,红霉素,氯霉素,头孢曲松,和甲氧苄啶-磺胺甲恶唑.验证了试纸和培养方法的诊断准确性，以确保检测UTI的可靠性。使用统计产品和服务解决方案（SPSS）软件进行统计分析（2019年发布；IBMCorp.,Armonk,纽约,美国)。结果在250名儿童中，根据培养方法，56（22.4％）为UTI阳性，根据试纸测试，62（24.8％）为UTI阳性。女孩比男孩更可能是UTI阳性（29.1%和13.6%，分别；p值=0.011)。大肠杆菌是最常见的尿路病原体,其次是克雷伯菌,葡萄球菌,Proteus,和假单胞菌（44.2%，26.9%,21.2%,3.8%,和1.9%，分别)。所有分离株均对氨苄氯有抗性。氨苄青霉素耐药率,红霉素,复方新诺明,氯霉素,头孢曲松占94.2%,76.9%,59.6%,46.2%,和21.2%，分别。结论本研究表明试纸诊断了更多的UTI。女孩的患病率高于男孩。大肠杆菌是最常见的抗生素耐药菌。对氨苄西林和氯唑西林的组合观察到高耐药水平。然而,分离株对头孢曲松的耐药性较低。这些结果要求在患有SCD的儿科人群中增加对耐药性尿路病原体的监测。
