Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
Department of Pediactrics, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
Ann Clin Microbiol Antimicrob. 2018 Jun 25;17(1):27. doi: 10.1186/s12941-018-0279-4.
In children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care.
Every inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed.
Frequency of UTI was significantly high among infants (p = 0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p = 0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs' prior to seek treatment from tertiary care pediatric unit (p = 0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p = 0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p = 0.04).
Medical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.
在儿童中，尿路感染（UTI）是一种常见的细菌感染。本研究旨在检测最初由全科医生治疗后转至三级保健的儿童的病原体、药敏性、与复发和肾瘢痕形成相关的病原体。
对每例入组的尿路感染患儿进行培养和药敏检测，同时收集过去 6 个月的感染史和抗菌药物使用情况，通过临床记录和抗菌药物使用情况进行演示。对复发性肾盂肾炎患儿进行随访，并评估体外生物膜形成情况。
UTI 在婴儿中的发生率明显较高（p=0.03）。过去 6 个月，所有（220 例）患儿均接触过抗菌药物。头孢克肟是最常开的抗菌药物（p=0.02）。在本次 UTI 发作中，220 例 UTI 患儿中有 64.5%（142/220）在寻求三级保健儿科单位治疗前曾咨询过全科医生（p=0.02）。在随访中，患有 UTI 的患儿发现尿液培养分离株明显从大肠埃希菌和肺炎克雷伯菌转变为超广谱β-内酰胺酶（ESBL）大肠埃希菌和肺炎克雷伯菌。在 208 名参与者中，36 名患有复发性肾盂肾炎（R-PN）。在 70 名患有肾盂肾炎的患者中，经二巯丁二酸扫描后发现 22 名患者存在肾瘢痕（RS）。每次复发性肾盂肾炎发作后，都有 11%的新瘢痕形成（p=0.02）。R-PN 患者中生物膜形成的大肠埃希菌和肺炎克雷伯菌显著相关（p=0.04）。
医疗保健提供者经常在没有病因诊断的情况下开具抗菌药物。而第三代头孢菌素和碳青霉烯类药物的持续暴露导致了 ESBL 和 CRE 微生物的大量出现。抗菌药物的经验性使用需要与当地的流行病学和抗菌药物敏感性模式相结合。儿童复发性肾盂肾炎导致肾瘢痕形成。生物膜形成是这些复发的主要原因。
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