Journal Article

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

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

2017

Overview

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. 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. 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%). 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Amoxicillin / Ampicillin / Antibiotics / Antimicrobial agents / Bacteremia / Bacteriuria - microbiology / Biology and Life Sciences / Care and treatment / Ceftriaxone / Cefuroxime / Child, Preschool / Children / Complications / Cotrimoxazole / Cross-Sectional Studies / Diagnosis / Drug resistance / E coli / Escherichia coli / Escherichia coli - drug effects / Escherichia coli - isolation & purification / Families & family life / Female / Fever / Fever - diagnosis / Fever - drug therapy / Fever - epidemiology / Fever - microbiology / Gentamicin / Health facilities / Hospitals / Humans / Hypertension / Illnesses / Infant / Infections / Kenya - epidemiology / Kidney transplantation / Malaria / Malaria - diagnosis / Malaria - drug therapy / Male / Medicine / Medicine and Health Sciences / Microbial Sensitivity Tests / Microscopy / Multidrug resistance / Nitrofurantoin / Pediatrics / People and Places / Public health / Pyuria / Research and Analysis Methods / Risk factors / Sample size / Scars / Staphylococcus aureus / Staphylococcus aureus - drug effects / Staphylococcus aureus - isolation & purification / Studies / Urinary tract / Urinary tract diseases / Urinary tract infections / Urinary Tract Infections - diagnosis / Urinary Tract Infections - drug therapy / Urinary Tract Infections - epidemiology / Urinary Tract Infections - microbiology / Urine / Urogenital system / Vector-borne diseases