Abstract
Background: Very common symptom in children, fever, perhaps a warning sign of more or less severe pathology, rapidly progressive, including an invasive bacterial infection such as acute pyelonephritis (APN). The aim of this work was to study the bacteriological profile and antibiotic sensitivity of APN in children. Methods: A prospective study involving any infant or child aged 3 months to 15 years with an acute fever (≥38°C) in which a urine test strip was performed in the pediatric department of the teaching hospital Gabriel Toure between April 1st and May 15th, 2019 (45 days). Results: 124 children were included out of 244 febrile patients. Infants (3 - 23 months) predominated (52.8%) with a sex ratio of 2. Seventy-five percent of children came directly from home and 30.6% were on antibiotic prior to admission. The urine bag sample was taken in 55.6% and the urine was macroscopically cloudy in 32.3%. Stigmas of urinary tract infection at the urinary strip were present in 56.5%. Confirmation of acute pyelonephritis (APN) by CytoBacteriological Urine Examination (CBUE) was 29% with Escherichia coli (63.9%) or Enterococcus faecalis (30.5%). Sensitivity was excellent for ciprofloxacin and imipenem (100%). The overall resistance was greater for gentamicin, cotrimoxazole, ceftriaxone, cefotaxime and amoxicillin-clavulanic acid (Threshold: 17.9% - 95.6%). APN was associated with bacteremia in 2.8% with hospitalization for 45.2% and mortality of 11.1% (due to severe acute malnutrition, severe dehydration and multifocal infection). Conclusion: The APN, daily activity of pediatrician in Bamako, is observed in one third of febrile children associated with a major life-threatening condition of risk factors, then the likely antibiotherapy could be amikacin in our context.
Highlights
Fever is an extremely common symptom in children [1]
A prospective study involving any infant or child aged 3 months to 15 years with an acute fever (≥38 ̊C) in which a urine test strip was performed in the pediatric department of the teaching hospital Gabriel Toure between April 1st and May 15th, 2019 (45 days)
From April 1st to May 15th, 2019, 1908 children aged between 03 months and 15 years were observed in the pediatric department of the teaching hospital Gabriel Toure and 244 children had at least 38 ̊C fever
Summary
As the leading cause of consultation in pediatric emergencies (15% to 20% in developed countries, higher in Africa), fever most often goes with minor and common self-limited infectious diseases [2] It can be a warning sign of more or less severe and rapidly progressive pathology including an invasive bacterial infection such as acute pyelonephritis (APN). Febrile urinary tract infection or APN is responsible for 95% of fever above 39 ̊C before 2 years [3] It is the severe bacterial infection (threatening renal parenchyma with risk of renal scarring or even long-term renal failure) the most common in pediatrics [4]. Very common symptom in children, fever, perhaps a warning sign of more or less severe pathology, rapidly progressive, including an invasive bacterial infection such as acute pyelonephritis (APN).
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