Pattern of Infection among Children with Nephrotic Syndrome in a Tertiary Level Hospital

Abstract

Background: Patients with nephrotic syndrome are susceptible to numerous bacterial, viral, and fungal infections. To design preventive measures, it is vital to identify the various types of infections, their causative organisms, and sensitivity patterns in the local settings. Methods: From January 2012 to July 2014, this descriptive cross-sectional study was conducted in the Pediatric department of Sir Salimullah Medical College, Mitford Hospital, Dhaka. Children younger than 12 years admitted with nephrotic syndrome were screened for infection. Laboratory analysis with culture and sensitivity of urine, blood, CSF, and peritoneal fluids was performed to identify and analyze the causative organisms. Results: The most prevalent age range for the 90 admitted children with nephrotic syndrome was 2-5 years, and the male to female ratio was 0.95:1. 73% of the children had their initial attack of nephrotic syndrome, while 27% had recurrence. During admission, 38% of patients had various infections, and 57% of these infections occurred in children aged 2 to 5 years. Urinary tract infection (UTI), peritonitis, septicemia, and pneumonia were the most prevalent illnesses (incidence, 46%, 26%, 11%, and 9%, respectively). Escherichia coli, Proteus sp., and Streptococcus sp., commonly caused urinary tract infections, peritonitis, septicemia, and pneumonia. Organisms for UTI, peritonitis and pneumonia were sensitive to ciprofloxacin, azithromycin, and ceftriaxone, respectively. Conclusion: Infection should be ruled out carefully in every case of nephrotic syndrome during management in the hospital. Escherichia coli is the dominant causative agent for UTI. After sending relevant body fluids for culture sensitivity, ciprofloxacin for a suspected UTI, and azithromycin for peritonitis can be started immediately.