Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya

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.

Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot comprehensive and specialized hospital, Northwest Ethiopia. A prospective study

“…Populations that have a major risk of acquiring a UTI are newborns, preschool children, sexually active women, and older individuals of both sexes [ 10 ]. Studies from developing countries showed that around 10% of children with febrile illnesses have a UTI and it extends to 8–35% if the patient is malnourished children [ 3 , 11 ].…”

“…In Tanzania, Children who presented prolonged duration of fever (7 days or longer) were more likely to have UTI, 16.8% [ 17 ]. Another study in Kenya on the contribution of urinary tract infection to the burden of febrile illnesses in young children reported about 11.9% share [ 11 ].…”

Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot Comprehensive and Specialized Hospital, Northwest Ethiopia. A prospective study

“…Populations who have a major risk of acquiring a UTI are newborns, preschool children, sexually active women, and older individuals of both sexes [10]. Studies from developing countries showed that around 10% of children with febrile illnesses have a UTI and it extends to 8-35% if the patient is malnourished children [3,11].…”

“…From this study, UTI takes an 11% share [15]. Similarly, a study on the prevalence of UTI in one Nigerian teaching hospital to determine the incidence of urinary tract infection in children and adolescents was 11.9% [16], Tanzania Children who presented prolonged duration of fever (7 days or longer) were more likely to have UTI 16.8% [17], in a study on the contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya was 11.9% [11].…”

Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot Comprehensive and Specialized Hospital, Northwest Ethiopia. A prospective study

“…Populations that have a major risk of acquiring a UTI are newborns, preschool children, sexually active women, and older individuals of both sexes [10]. Studies from developing countries showed that around 10% of children with febrile illnesses have a UTI and it extends to 8-35% if the patient is malnourished children [3,11].…”