Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural KenyaReportar como inadecuado




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Introduction

The 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.

Methods

A 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.

Results

A 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%.

Conclusion

Our 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.



Autor: Wechuli Geoffrey Masika , Wendy Prudhomme O’Meara, Thomas L. Holland, Janice Armstrong

Fuente: http://plos.srce.hr/



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