Das R, Ahmed T, Saha H, Shahrin L, Afroze F, Shahid A S M S B, Shahunja K M, Bardhan P K, Chisti M J
Nutrition and Clinical Services Division (NCSD),International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Mohakhali,Dhaka,Bangladesh.
Epidemiol Infect. 2017 Apr;145(5):1018-1024. doi: 10.1017/S0950268816002971. Epub 2016 Dec 28.
Urinary tract infection (UTI) is common in children aged <5 years with diarrhoea, but little is known about risk factors, aetiology and outcome of such children. We aimed to evaluate these knowledge gaps of UTI in children aged <5 years with diarrhoea. We enrolled all children aged <5 years with diarrhoea admitted to Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between May 2011 and April 2013, who had history of fever (⩾38 °C) and obtained a urine sample for culture. Diarrhoea with UTI (confirmed by culture) constituted cases (n = 26) and those without UTI constituted controls (n = 78). Threefold controls were randomly selected. The case-fatality rate was comparable in cases and controls (4% vs. 1%, P = 0·439). Escherichia coli (69%) and Klebsiella (15%) were the most commonly isolated pathogens. Persistent diarrhoea, pneumonia and prior antibiotics use were identified as risk factors for UTI in logistic regression analysis (P < 0·05 for all). Thus, children with diarrhoea presenting with persistent diarrhoea, pneumonia, and prior antibiotic use should be investigated for UTI for their prompt management that may reduce morbidity.
尿路感染（UTI）在5岁以下腹泻儿童中很常见，但对于这类儿童的危险因素、病因及预后了解甚少。我们旨在评估5岁以下腹泻儿童尿路感染方面的这些知识空白。我们纳入了2011年5月至2013年4月期间入住孟加拉国腹泻病研究国际中心达卡医院的所有5岁以下腹泻儿童，这些儿童有发热（≥38°C）病史，并采集了尿液样本进行培养。腹泻合并尿路感染（经培养确诊）的儿童构成病例组（n = 26），未合并尿路感染的儿童构成对照组（n = 78）。随机选取三倍数量的对照组。病例组和对照组的病死率相当（4% 对1%，P = 0.439）。大肠埃希菌（69%）和克雷伯菌（15%）是最常分离出的病原体。在逻辑回归分析中，持续性腹泻、肺炎和既往使用抗生素被确定为尿路感染的危险因素（所有P < 0.05）。因此，对于出现持续性腹泻、肺炎且既往使用过抗生素的腹泻儿童，应进行尿路感染检查以便及时处理，这可能会降低发病率。
