Abstract
IntroductionThe clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood.MethodsA cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture.ResultsA total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%).ConclusionOur study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.
Highlights
The clinical features of Urinary tract infections (UTI) in young children may not localize to the urinary tract and closely resemble other febrile illnesses
Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections
Febrile illness is typically presumptively treated as malaria in African children in endemic areas, where the majority of these children are given anti-malarial drugs [2,3,4]
Summary
A cross-sectional study was carried out in a hospital in western Kenya. Microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture. This study was conducted at Webuye Sub-county Hospital, a government hospital in Kenya located in Western Province, Bungoma County along the Nairobi-Uganda highway, approximately 400km northwest of Nairobi. The hospital serves as a referral centre for lower-level health facilities in the Sub-county. The hospital admits approximately 12500 patients, including 3200 pediatric patients. The pediatric ward has 56 beds and admits on average 250 children per month. Most of the patients are referred from or come as self-referrals after treatment has been initiated at lower-level facilities
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