Mitiku Enkosilassie, Amsalu Anteneh, Tadesse Birkneh Tilahun
Department of Medical Microbiology Laboratory, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.
University of Gondar, Department of Microbiology.
Ethiop J Health Sci. 2018 Mar;28(2):187-196. doi: 10.4314/ejhs.v28i2.10.
Failure to timely diagnose and treat urinary tract infections is associated with grave long term consequences. The objectives of this study included assessing the proportion and predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department (OPD) visits and determining common uropathogens with antimicrobial susceptibility pattern.
A cross sectional study was conducted from May to September 2015 among children of less than 15 years old at a tertiary center in Hawassa, Ethiopia. Children who fulfilled predefined eligibility criteria were recruited to undergo urine culture and urine analysis.
A total of 863 children visited the OPD during the study period among which 269(31.2%) fulfilled the predefined eligibility criteria. Urine culture was positive for 74/269(27.5%) of the clinically suspected children. Male uncircumcision (adjusted odds ratio (aOR) 3.70; 95% CI 1.34-10.16) and under nutrition (aOR 5.41; 95%CI 2.64-11.07) were independent predictors of culture positivity. More than 5 WBC per high power field (aOR 4.7, 95% CI 1.8-12.7) on microscopy, urine PH > 5.0 (aOR 2.6, 95%CI 1.2-5.8), and positive leukocyte esterase (aOR 9.9, 95%CI 4.1-25.7) independently predicted positive growth on urine culture. Escherichia coli (34/74, 45.9%) and Klebsiella spp (18/74, 24.3%) were the most frequent isolates. High resistance was noted against amoxicillin (70.6%) and cotrimoxazole (97.1%) by E. coli.
UTI accounted for a tenth of total OPD visits. Commonly used first line antibiotics showed high level resistance to common etiologies of UTI. UTI should be suspected in febrile children, and antibiograms should be done to tailor prescription of antibiotics.
未能及时诊断和治疗尿路感染会带来严重的长期后果。本研究的目的包括评估作为儿科门诊就诊原因的尿路感染（UTI）的比例和预测因素，以及确定具有抗菌药敏模式的常见尿路病原体。
2015年5月至9月在埃塞俄比亚哈瓦萨的一家三级中心对15岁以下儿童进行了一项横断面研究。符合预定义纳入标准的儿童被招募进行尿培养和尿液分析。
在研究期间共有863名儿童到门诊就诊，其中269名（31.2%）符合预定义纳入标准。临床疑似儿童中74/269（27.5%）的尿培养呈阳性。男性未行包皮环切术（调整比值比（aOR）3.70；95%可信区间1.34 - 10.16）和营养不良（aOR 5.41；95%可信区间2.64 - 11.07）是培养阳性的独立预测因素。显微镜检查每高倍视野白细胞超过5个（aOR 4.7，95%可信区间1.8 - 12.7）、尿液pH > 5.0（aOR 2.6，95%可信区间1.2 - 5.8）以及白细胞酯酶阳性（aOR 9.9，95%可信区间4.1 - 25.7）独立预测尿培养阳性生长。大肠埃希菌（34/74，45.9%）和克雷伯菌属（18/74，24.3%）是最常见的分离株。大肠埃希菌对阿莫西林（70.6%）和复方磺胺甲恶唑（97.1%）耐药率高。
尿路感染占门诊就诊总数的十分之一。常用的一线抗生素对尿路感染的常见病因显示出高耐药性。发热儿童应怀疑有尿路感染，应进行药敏试验以调整抗生素处方。
