The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition

Thuo, Nahashon; Ohuma, Eric O; Karisa, Japhet; Talbert, Alison; Berkley, James A.; Maitland, Kathryn

doi:10.1136/adc.2009.168211

Cited by 16 publications

(17 citation statements)

References 29 publications

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“…10,11 Rare organism like Acinetobacter 1(3.7%) was also reported in this studies. Similar reports were also noted in the study by Caksen et al, and Thuo et al 8,12 As reported by Rabasa et al, antibiotic sensitivity patterns vary from one study to another. 5 In this study, microorganisms showed antibiotic sensitivity pattern in the following order: Amikacin (100%)> ciprofloxacin (81.4%)> cefotaxime (7% In this study, we did not have controls.…”

Section: Discussionsupporting

confidence: 85%

Prevalence of urinary tract infection in malnourished children aged 6 months to 5 years attending tertiary care centre

Kumar¹,

Gowrinathan²

2019

Int J Contemp Pediatr

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Background: Infections are more common in malnourished children, as result of impaired immunity. Unexplained fever and failure to thrive are the common presenting features of urinary tract infection (UTI) in children. In malnourished children, UTI is mostly asymptomatic and is leading to pyelonephritis and renal scarring. The study was done with the aim to evaluate and find out the prevalence of urinary tract infection in malnourished children between 6 months to 5 year and to find out the causative organism and antibiotic sensitivity pattern.Methods: A total of 180 cases of malnourished children were enrolled and clean catch midstream urine sample was collected for urine culture, according to WHO criteria of malnutrition. Children with urinary tract abnormality were excluded from the study. Renal USG was done in all urine culture positive cases.Results: Total of 174 cases was present after exclusion. Of 174 children, 27 (15.5%) children were having UTI. In this study, 37% of children are asymptomatic. E. coli is the commonest organism causing UTI 16 (59%). Other organism are Klebsiella pneumonia 4 (14.9%), Proteus mirabilis 3 (11.1%), and Pseudomonas 3 (11.1%). The order of antimicrobial sensitivity pattern was amikacin (100%)> ciprofloxacin (81.4%)> cefotaxime (7%). Other common drugs have developed resistance to these organisms.Conclusions: Our observations conclude that malnourished children with fever of unknown origin are at risk of UTI. Hence, urine analysis and culture tests are to be done to all malnutrition cases for assisting to diagnose the bacterial infection and providing the appropriate treatment.

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Section: Discussionsupporting

confidence: 85%

Prevalence of urinary tract infection in malnourished children aged 6 months to 5 years attending tertiary care centre

Kumar¹,

Gowrinathan²

2019

Int J Contemp Pediatr

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“…The prevalence of UTI in malnourished children in this study although lower than some previous reports (10,16,11,7,9,12,13) but is however higher than some other studies (6,8,14,15) (Table-VI). The wide variation in prevalence of UTI can be explained by the use of different study methods, geographical variation, as well as considerations or no considerations of study confounders.…”

Section: Discussioncontrasting

confidence: 76%

“…Rabasaet al 6 Nigeria 11% Shimeleset al 7 Ethiopia 37% Thuoet al 8 Kenya 6% Ahmed et al 9 Tanzania 20.3% Kala et al 10 South Africa 34.7% Berkowitz 11 South Africa 31% Caksenet al 12 Turkey 30% Brown et al 13 Bangladesh 30% Banapurmathet al 14 India 8% G. Gopalet al 15 India 11.34% Reed RP 16 Africa 26.1% Present Study (2017-18) Dibrugarh, Assam, India 16.67%…”

Section: Country Uti Prevalencementioning

confidence: 90%

Prevalence of Urinary Tract Infection in Malnourished Children

Dey¹,

Biswas²

2019

jemds

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BACKGROUND Malnutrition involves hundreds of millions of children in the developing world. Malnutrition and infection is a vicious cycle. Malnourished children suffer from many infections like respiratory tract infection, UTI, diarrhoea. UTI is more common in malnourished children, and risk of UTI is related to severity of malnutrition. Severe acute malnutrition (SAM) is associated with immune deficiency, because of which they are more vulnerable to severe infection. Risk factors for urinary tract infection include female gender, uncircumcised male, vesicoureteral reflux, poor toilet training, voiding dysfunction, obstructive uropathy, urethral instrumentation, wiping from back to front in girls, bubble bath, tight clothing (underwear), pinworm infestation, constipation, sexually activity, neuropathy bladder, anatomic abnormality (labial adhesion), bacteria with P fimbriae and under nutrition. Urinary tract infection (UTI) is more common in malnourished children, and risk of UTI is related to severity of malnutrition. Severe acute malnutrition (SAM) is associated with immunodeficiency, for which they are more vulnerable to severe infection. We wanted to study the prevalence of UTI in malnourished children. METHODS 72 malnourished children (WHO classification) who met the inclusion criteria were included in this study from June 2017 to Ma y 2018. Detailed anthropometric measurements were done and grading of malnutrition was done according to WHO classification. Urine for routine examination and culture and sensitivity was done for each case. Early morning urine was collected. In children below 3 years of age urine was collected by catheterization and in toilet trained children (> 3 years of age) midstream clean catch urine sample under strict asepsis was collected in a sterile container. After collecting urine sample was sent within one hour to the laboratory. RESULTS UTI was found in 16.67% cases, mostly in female and more frequently in 6-12 months age group and most common organisms was gram negative bacilli. CONCLUSIONS Among the various risk factors of urinary tract infection, malnutrition especially under-nutrition itself is a risk factor for UTI or sometimes urinary tract infection also can lead to malnutrition. UTI is common in malnourished children and most common causative organisms are gram negative bacilli.

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“…A recent prospective observational study among Kenyan hospitalized SAM children showed the predictive value of a positive urine dipstick (either Leucocyte esterase or Nitrites) on mortality (29% vs. 12%, adjusted HR = 2.5) [64]. It also showed high resistances>50% of Coliforms to Cotrimoxazole and Gentamycin.…”

Section: Resultsmentioning

confidence: 99%

Do Children with Uncomplicated Severe Acute Malnutrition Need Antibiotics? A Systematic Review and Meta-Analysis

Alcoba¹,

Kerac

Breysse

et al. 2013

PLoS ONE

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BackgroundCurrent (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.Methods and FindingsOVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27–55%) vs 22% (IQR 17–23%) and population-weighted-means 52.9% (range 23–57%) vs 35.4% (range 6.7–42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM.ConclusionsThe evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy.

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The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition

Abstract: A urine dipstick positive for either LE or nitrites is a useful predictor of death in children admitted with SAM. Prospective studies to determine the role of untreated UTI in these deaths are needed before any treatment recommendations can be made.

Cited by 16 publications

References 29 publications

Prevalence of urinary tract infection in malnourished children aged 6 months to 5 years attending tertiary care centre

Prevalence of urinary tract infection in malnourished children aged 6 months to 5 years attending tertiary care centre

Prevalence of Urinary Tract Infection in Malnourished Children

Do Children with Uncomplicated Severe Acute Malnutrition Need Antibiotics? A Systematic Review and Meta-Analysis

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