Profile Of Children’s Urinary Tract Infection, Evaluation Of Risk Factors And Review Of The Literature

Abstract

It is important to indicate the distribution and alteration of the factors of urinary tract infections in children and of the resistance ratios according to years and to probe the accompanying risk factors. In this study, the records of Microbiology Laboratory and Pediatric Clinic of İzmir Menemen State Hospital were searched retrospectively. In the course of the study, 105 cfu/ml and single microorganism growth were taken under evaluation in urine cultures. A total of 2669 urine cultures were evaluated; in 456 of them (17%) significant growth was detected in terms of urinary tract infection. 275 (60%) of the samples with reproduction belonged to girls and 181 (40%) of them belonged to boys. Escherichia coli was the most commonly reproduced microorganism in 64% patients. Klebsiella spp. was determinant in %16 patients, Proteus spp. in %8 patients , Enterococcus spp. in %5 patients, Pseudomonas aeruginosa in %3 patients, Staphylococcus aureus in %2 patients, Coagulase Negative Staphylococcus in %2 patients. In E.coli strains, 66% resistance was detected to ampicilline, 16% to amoxicilline clavulanate, 28% to ampicilline/sulbactam, 14% to ceftazidime, 25% to ceftriaxone, 6% to nitrofurantoine, 6% to phosphomisine, 0% to imipenem, 29% to trimethoprim sulfamethoxazole, 23% to gentamicine. Ampicillin was the antibiotic against which the highest resistance was determined by 100% for Klebsiella spp. and by 71% for Proteus spp. In the childhood urinary tract infections, more resistance to ampicillin, ampicillin/sulbactam, gentamicin and TMP-SMX, frequently preferred as the first option, was found than the others. During this study period, the resistance to meropenem and imipenem was not found in childhood group. ESBL positive Gram negative bacteria rate was 69/456 (15%). A total of 59 of them were E.coli, 10 of them were Klebsiella spp. Today, nitrofurantoin, aminoglycosides are the antibiotics that can still be suggested in empirical treatment due to the low resistance. Yet, the continuation of the antibiotic treatments started empirically must be decided again after the culture and susceptibility test results reported by microbiology laboratory are interpreted, as suggested in guides.