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

Abstract

This study was undertaken to observe the clinical and laboratory profile of Urinary Tract Infection (UTI) in children attending paediatric outpatient department (OPD) of Combined Military Hospital (CMH) Dhaka.  Urinary Tract Infection (UTI) implies the presence of actively multiplying organisms in the urinary tract. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with UTI. This cross-sectional observational study was conducted at CMH Dhaka from June 2015 to May 2016. This study included 120 children aged 0 months to 12 years who presented to a paediatric OPD with symptoms of suspected UTI. Urine analysis, including microscopy and culture sensitivity, was performed on all of the children. Other pertinent workups were also completed. Clinical and laboratory profiles were obtained and recorded in case record form following enrollment. The 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 the genital area from back to front (91.7%), irregular anthelminthic 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 a significantly higher rate of UTI. Among all urine analyses 75% of urine samples revealed pyuria. Urine culture was positive in 58 (48.3%) of the subjects, with Escherichia coli being the most commonly isolated organism (62%). Ciprofloxacin and Levofloxacin were extremely toxic to common organisms. In 17.5% of cases, ultrasonography (USG) of the entire abdomen revealed abnormal findings. In 25% of cases, there was a high Erythrocyte Sedimentation Rate (ESR) and neutrophilic leukocytosis. This study discovered that UTI was more common in females and children under the age of five. The most common symptom was fever, and uncircumcised boys had a significantly higher rate of UTI. The most common isolated organism was Escherichia coli, but it was resistant to commonly used antibiotics such as Amoxycillin and Cephalosporines. Ciprofloxacin and Levofloxacin can be used empirically for UTI treatment in the outdoor setting of Combined Military Hospital (CMH) Dhaka after sending urine culture and sensitivity. Thus, antibiotic use in UTIs should be institutionalized according to the organism’s sensitivity.