Abstract
Choosing the antimicrobial agent for initial therapy of urinary tract infection (UTI) is usually empirical and should consider the prevalence of uropathogens in different age groups and gender. To establish prevalence rates of uropathogens in community-acquired UTI in relation to age and gender. Cross-sectional study conducted in the emergency department (ED) of a general hospital, from January to December, 2010, in patients younger than 15 years old who had clinical suspicion of UTI and collected quantitative urine culture. UTI was defined as urine culture with growth of a single agent > 100.000 colony forming units (cfu)/mL in a midstream collection or ≥ 50.000 cfu/mL in urethral catheterization. There were 63.464 visits to ED. 2577 urine cultures were obtained, of whom 291 were positive for UTI (prevalence = 11.3% of clinical suspicion and 0.46% of visits), 212 cases (72.8%) in females, median age = 2.6 years. The predominant uropathogen was E. coli (76.6%), followed by Proteus mirabilis (10.3%) and Staphylococcus saprophyticus (4.1%). Among infants < 3 months, prevalence rates of E. coli were significantly lower (50% vs 78.4%; OR = 0.276; p = 0.006). Higher prevalences of Staphylococcus saprophyticus occurred among patients > 10 years (24.4% vs 0.4%; OR = 79.265; p < 0.0001). Proteus mirabilis was significantly more prevalent in boys than girls (24.0% vs 5.2%; OR = 5.786; p < 0.001). E. coli was the most prevalent community-acquired uropathogen. Nevertheless, initial empiric antimicrobial treatment of UTI should consider the significant prevalence of other agents different from E. coli in infants < 3 months, the high prevalence of Staphylococcus saprophyticus in patients > 10 years and Proteus mirabilis in males.
Highlights
Choosing the antimicrobial agent for initial therapy of urinary tract infection (UTI) is usually empirical and should consider the prevalence of uropathogens in different age groups and gender
Crosssectional study conducted in the emergency department (ED) of a general hospital, from January to December, 2010, in patients younger than 15 years old who had clinical suspicion of UTI and collected quantitative urine culture
UTI was defined as urine culture with growth of a single agent ≥ 100.000 colony forming units/mL in a midstream collection or ≥ 50.000 cfu/mL in urethral catheterization
Summary
Infecção do trato urinário (ITU) é uma doença frequente na prática clínica pediátrica.[1,2] Os sintomas clássicos de ITU como disúria, polaciúria, urgência miccional e dor lombar nem sempre estão presentes em crianças pré-verbais, podendo ser a febre o único sintoma em lactentes.[3]. A escolha da terapia antimicrobiana empírica deve ser baseada no conhecimento de dois princípios básicos: primeiro, a prevalência dos agentes etiológicos mais frequentes para cada faixa etária e sexo; e segundo, o conhecimento do perfil de sensibilidade antimicrobiana destes uropatógenos, que pode ser variável em cada comunidade e ao longo do tempo. O principal agente etiológico de ITU em diversas casuísticas nacionais e internacionais é Escherichia coli (E. coli), com prevalência variável entre 60% a 90%, de acordo com a localidade do estudo e faixa etária.[7,8,9,10,11,12,13,14,15,16] O conhecimento de sua sensibilidade antimicrobiana é importante na decisão da terapia empírica inicial. As amostras foram imediatamente encaminhadas ao laboratório de microbiologia do hospital e cultivadas em meio ágar sangue e ágar MacConkey (Plastlabor®, Rio de Janeiro), sendo a identificação e sensibilidade das cepas isoladas determinadas pelo sistema Vitek® 2 (bioMérieux, Marcy l’Etoile, França)
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