RESUMO
Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.
RESUMO
Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure