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Causative agents and their antimicrobial sensitivities in hospitalised children with recurrent urinary tract infections: Experience in a paediatric nephrology unit

Authors:

Niranjalee Samanthika Egodawaththe ,

Teaching Hospital Peradeniya, LK
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Shenal Thalgahagoda,

Teaching Hospital Peradeniya, LK
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Gihani Vidanapathirana

Teaching Hospital Peradeniya, LK
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Abstract

Introduction: Urinary tract infection (UTI) has a significant morbidity highlighting the importance of preventing recurrences. Knowledge on aetiological agents and their antibiotic sensitivities is crucial for proper management of affected children.


Objectives: To determine the causative microorganisms and their antibiotic sensitivity pattern in patients with recurrent UTIs on uroprophylaxis and to compare the first episode of UTI with recurrent UTIs regarding causative organisms and antibiotic sensitivity.


Method: A descriptive study was done at Teaching Hospital Peradeniya, recruiting children aged 1 month to 14 years, admitted from 1st May 2019 to 30th April 2020 with breakthrough febrile or symptomatic UTIs after being on antibiotic prophylaxis. Details were collected using a validated and pre-tested questionnaire.


Results: A total of 141 UTIs of 52 children were analysed. There were 31 (59.6%) boys; 76.3% episodes were febrile and 22.7% were afebrile but symptomatic UTIs. Micturating cystourethrogram revealed that 29 (56%) children had vesico-ureteric reflux; renal scarring was noted in the majority; 24 (46.1%) children had bladder and bowel dysfunction. Constipation was found in 29 (55.7%). Main pathogens implicated in recurrent UTIs were Escherichia coli (E coli) (55%), Klebsiella species (14.6%) and Pseudomonas aeruginosa (13.5%). First episodes were caused by E coli (57.7%), Klebsiella species (17.3%) and Proteus mirabilis (11.5%). Imipenem (89.8%), amikacin (87.7%) and ciprofloxacin (87.7%) were the most sensitive antibiotics for E coli. Sensitivity of E colito cotrimoxazole was significantly decreased during recurrent episodes (p=0.025). More than 2 UTIs were significantly associated with age above 24 months, female gender, constipation, bladder bowel dysfunction (BBD) and renal scarring.


Conclusions: Primary and recurrent UTIs in children were mainly caused by E coli. Antibiotic sensitivity rates of E. coli were comparatively lower in recurrent UTIs. Age above 24 months, female gender, constipation, BBD and renal scarring showed a significant association with multiple UTI recurrences.


Sri Lanka Journal of Child Health, 2022; 51(1)75-83

How to Cite: Egodawaththe, N.S., Thalgahagoda, S. and Vidanapathirana, G., 2022. Causative agents and their antimicrobial sensitivities in hospitalised children with recurrent urinary tract infections: Experience in a paediatric nephrology unit. Sri Lanka Journal of Child Health, 51(1), pp.75–83. DOI: http://doi.org/10.4038/sljch.v51i1.10000
Published on 05 Mar 2022.
Peer Reviewed

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