Masika Wechuli Geoffrey, O'Meara Wendy Prudhomme, Holland Thomas L, Armstrong Janice
Department of Family Medicine, Webuye Sub-County Hospital, Webuye, Kenya.
Department of Family Medicine, Kabarak University, Kabarak, Kenya.
PLoS One. 2017 Mar 21;12(3):e0174199. doi: 10.1371/journal.pone.0174199. eCollection 2017.
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.
幼儿尿路感染的临床特征可能并不局限于尿路，与其他发热性疾病极为相似。在疟疾流行地区，发热儿童往往未经尿路感染检查就被按疟疾进行推定治疗。尿路感染治疗延迟或不充分会增加幼儿发生菌血症和肾瘢痕的风险，进而增加成年后患高血压和终末期肾病等并发症的风险。
在肯尼亚西部的一家医院开展了一项横断面研究。2012年9月至2013年4月期间，纳入了年龄在2个月至5岁之间、腋窝温度≥37.5°C且前一周未使用抗生素的住院患者和门诊患者。进行了尿试纸检测、显微镜检查和培养，并确定了对常用抗生素的药敏模式。尿路感染定义为脓尿（尿试纸检测或显微镜检查呈阳性）加尿培养呈阳性。
共招募了260名受试者；45.8%为女性，中位年龄为25个月（四分位间距：13, 43.5）。尿路感染的总体患病率为11.9%。住院患者的患病率高于门诊患者（17.9%对7.8%，p = 0.027）。尿路感染与疟疾并存，但相关性不显著（比值比0.80，p = 0.570）。分离出的最常见病原体为大肠埃希菌（64.5%）和金黄色葡萄球菌（12.9%），它们对环丙沙星、头孢呋辛、头孢曲松、庆大霉素和呋喃妥因敏感，但对更常用的抗生素如氨苄西林（0%）、阿莫西林（16.7%）、复方新诺明（16.7%）和阿莫西林-克拉维酸（25%）大多耐药。
我们的研究表明，尿路感染对幼儿发热性疾病负担有显著影响，且常与其他感染并存。多重耐药菌很常见，因此抗菌治疗的选择应基于当地的药敏模式。
