URINARY TRACT INFECTION IN PEDIATRIC PATIENTS : STUDY IN TERTIARY CARE CENTRE IN BIHAR

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections seen in patient. Neonates, girls, young women, and older men are most susceptible to UTIs. Around 1% of boys and 5% of girls develop UTI during first ten years of life. Gram negative enteric bacilli, especially Escherichia coli and Klebsiella spp. are the leading pathogens though Enterococcus spp., yeasts and Staphylococcus aureus have emerged as prominent agents in recent years, many of them resistant to multiple antibiotics. The diagnosis of UTI in children possess a big challenge to the clinicians and several reasons have been responsible for the difficulties in establishing the diagnosis of UTI in children include; non-specific clinical presentation and the difficulty in getting urine sample for laboratory investigations. This study aims at finding the prevalence of UTI, describing presenting symptoms and the proportion found to have a UTI when urine samples were systematically requested from all eligible children. This study also assessed the magnitude of UTI among febrile children. Material and methods: Present study was carried out in pediatric department of NMCH, Patna from November 2017 to October 2018. During this period 400 pediatric patients (1 month -12 years) who presented in OPD or who were admitted in ward with complaint of fever or any urinary symptom were included in this study. Microscopy was done to detect pyuria (> 10pus cell/high power field), bacteriuria, haematuria or candidiuria of well mixed un-centrifuged urine samples. A specimen was considered positive if a single organism was isolated at a concentration greater than 10 5CFU/mL and associated with microscopy findings of greater than 10pus cell/ high power field. Result: Out of 400 these patients, 230 were males and 170 were female children. Significant bacteriuria was found in 96 cases, 42 males and 54 females. Fever was the most common consistent symptom present in 107 (70.8%) patients with UTI. Other physical findings in our study which were predominant after fever were dysuria (40.6%), Burning micturition (26.04%) and abdominal pain (21.76%). Our study showed UTI was more common in females than male patients. The ratio of female: males in over study were 1.3:1. Prevalence of E.coli and Klebsiella was high in girls. Although E. coli, Klebsiella were the principal uropathogens in our study, there were other pathogens of our interest due to their resistance pattern like, Pseudomonas, Proteus, Staphylococcus, Acinetobacter and Enterobacter. Resistance in these pathogen was as high as E.coli and klebsiella. Proteus was the third most common isolates in our study occupying 10.41% of all isolates which was well justified by other study. [14, 15, 16] Pseudomonas was isolated in 8.33% of UTI cases. This high prevalence of pseudomonas in comparison to may be due to inclusion of admitted patients. Conclusion: UTI has significant prevalance in pediatric age group in our region. Fever along with dysuria is most common presentation of UTI. Culture sensitivity pattern must be done for efficient treatment of UTI. Resistance among organism causing UTI keeps on changing with time. In case of admitted patient psuodomonas and other virulent organism must be taken into account before starting antibiotic therapy. It is important for clinician in order to facilitate the empiric treatment of patients and management of patients with symptoms of UTIs. Moreover, the data would also help to formulate antibiotic prescription policies.