Clinical profile and antibiotic sensitivity pattern in pediatric urinary tract infection of a tertiary care hospital in Bhubaneswar, Odisha

Urinary Tract Infection (UTI) is the most common infection encountered in children and fever is the presenting symptom in most of the cases. It is very difficult to diagnose UTI in pediatric age group especially in young infants because of vague, minimal and non-specific, symptomatology. But its early diagnosis is important in children as it may be the marker of urinary tract abnormalities and secondly it can lead to pathological changes in kidneys and urinary tract if not promptly and adequately treated.

The aim of this study was to determine demographic pattern, clinical profile, common uropathogens involved and their antibiotic sensitivity/resistance pattern in all culture positive UTI cases in children admitted to a tertiary care hospital in Odisha, so that it will be very helpful to the paediatricians in this region in better management of UTI cases in children.

This retrospective analytical study was carried out at Kalinga Institute of Medical Sciences, Bhubaneswar during the period from January 16 to December 16. A total of 150 pediatric patients aged ≤ 15 yrs having culture positive UTI were included in the study. Newborns, acute kidney injury at the time of admission, chronic kidney disease cases were excluded.

Fever was the common presenting symptom found in 76% children, vomiting was present in 20% and loose motion in 11.3%. Associated co-morbidity was detected in significant number (28.6%) of cases, that includes anemia, pneumonia, nephrotic syndrome, scrub typhus and sickle cell disease. Majority of our cases (70%) didn't have significant leucocyturia. Major organisms isolated in decreasing order were Escherichia Coli (45.3%), Enterococcus fecalis (34.6%) and Klebsiella spp (10%). Proteus mirabilis was isolated only in one case. Majority of E. Coli, Klebsiella, Acinetobacter and Staphylococcus aureus were sensitive to Amikacin but Enterococcus expressed high sensitivity to Linezolid and Vancomycin.

UTI should be considered as a potential cause of fever in children even after confirming other disease in a febrile case; urine analysis should be done as UTI may be an associated disease. Further absence of fever is not a criterion to exclude the possibility of UTI. Urine culture should be done as a diagnostic evaluation even if routine analysis does not reveal leucocyturia or bacteruria.

UTI is one of the common bacterial infections in infants and children next only to respiratory infection. Delay in diagnosis and/or definitive treatment may lead to long term sequel like hypertension, renal failure and CKD. Thus it warrants a high level of clinical acumen from the treating paediatrician in diagnosing and initiating prompt and proper treatment.