RESUMO
Objective: To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infection
Subjects and Methods: Urine samples were collected in infants 0-3 months of age presenting with features of sepsis. Two methods of collection were used, one was bag attached to perineal skin and the other was suprapubic aspirate. Within 30 minutes of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture technique
Setting: This cross sectional study was conducted at Shaikh Zayed hospital Lahore. The duration of study was six months. A total of 100 cases fulfilling the inclusion criteria were included in this study. Results were analyzed according to SPSS 16
Results: Out of 100 patients [n=100] 17 had positive bag culture, only 4 out of 17 had culture positive by SPA, so there were 13 false positives while using bag collection method
Conclusion: Suprapubic aspiration showed the positive yield in 4 SPA which does not indicate contamination and sterile urine bag showed the highest contamination rate among the two methods of urine sample collection. So urine bag leads to unnecessary treatment burden on the child and family. There fore we cannot rely on bag samples for diagnosis of urinary tract infections specially the bag collection method because the specificity of bag collection method is very low
RESUMO
Objecctives: To assess the role of serial C-reactive protein in the diagnosis of sepsis during the early period of infancy [<90 days]
Materials and Methods: This cross sectional study was conducted in the pediatrics Department of Shaikh Zayed Hospital [SZH], Lahore. The duration of study was 6 months from 1[st] July to 31[st] December 2010. Total 150 cases fulfilling the inclusion criteria were enrolled randomly in the study. Babies were divided in two groups: Group 1 -Healthy babies. Group II- Babies with sign and symptoms of sepsis. The first C-reactive protein and blood cultures were sent in all cases at the time of admission. Antibiotics were started in the suspected cases of sepsis. After 48 hours of admission, second sample of C-reactive protein was again sent in all cases
Results: The study was carried out in babies <90 days admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 [45.33%] culture proven cases of sepsis and 82 [54.67%] cases were culture negative. Escherichia coli was the most common organism isolated followed by Staphylococcus aureus. Males [63%] were predominant as compared to females [37%]. 80% were term babies while 20% were preterm. 75% babies were born by lower segment caesarian section, 15% were delivered at home while 10% were born at the private clinics. Early onset sepsis was seen in 39.33% of cases while late onset sepsis was seen in 60.67% cases. Mechanical ventilation was done in 10 babies [6.6%]. 97.4% babies survived and 2.6% babies expired. The sensitivity, specificity, PPV, NPV of C-reactive protein was 91.18%, 53.66%, 62% and 88% respectively at the time of admission. The CRP level was statistically different between the two group [p<0.001], at the time of admission and at 48 hours after admission
Conclusion: Babies during the early infancy period are susceptible of developing sepsis that may lead to potential consequences if not treated in proper time. Also babies may be over-treated and may have prolonged stay in the hospital if not properly investigated, which may itself be a burden to the family members and have a financial instability also. So keeping in mind all these factors, were performed a serial CRP test at admission and after 48 hours for treatment monitoring and observing the response. Sensitivity of C-reactive protein and negative predictive value was high in this study at the time of admission. So, serial monitoring of C-reactive protein is recommended for the monitoring treatment response