Arab Journal of Nephrology and Transplantation

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Acute Urinary Tract Infections in Children in Khartoum State: Pathogens, Antimicrobial Susceptibility and Associated Risk Factors

E Ali, A Osman


Introduction: Adequate treatment of acute urinary tract infections (UTIs) in children depends on knowledge of the local pattern of causative pathogens and associated risk factors. We explored these patterns and risk factors in a group of Sudanese children who attended the emergency department of Gaafar Ibn Auf Pediatric Hospital in Khartoum, Sudan, with symptoms of acute UTI.
Methods: Urine culture and sensitivity testing was performed for symptomatic children who had positive urine dipstick tests for nitrates and leuckocyte esterase.
Results: Acute UTI was confirmed in 100 children, 74% of them were below 5-years of age and 35% were infants. The male-female ratio of affected children was 2.1:1 among infants, and 1:1.2 among older children. Uncircumcision and infancy were significantly more prevalent among children confirmed to have UTI compared to children with non-signifiacnt bacteruria. E. coli was the most commonly isolated pathogen (60%). Mean susceptibility of all isolates was high to gentamicin (96%), ciprofloxacin (94%), ceftriaxone (90%), and cefixime (85%). Mean susceptibility was moderate to cefuroxime (75%), nalidixic acid (74%), and nitrofurantoin (70%), and low to cephelexin (51%), cotrimoxazole (26%), amoxicillin-clavulanate (19%) and ampicillin (14%). Ultrasound scan was feasible in 89 children with confirmed UTI, revealing renal stones in six children (6.7%). Micturating cysto-urethrogram (MCUG) was indicated for 28 children but was feasible for only 15 children, revealing low-grade vesico-ureteric reflux (VUR) in five of them.
Conclusion: E. coli was the commonest causative organism of acute UTI in our setting. Isolated pathogens were highly resistant to conventional empiric therapy. Male uncircumcision was significantly associated with UTI among the study patients.

Keywords: Acute Urinary Tract Infections, Children, Pathogens, Antimicrobial susceptibility, Sudan
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