Study of Clinical Profile in Urinary Tract Infections in 1-12 Years Childrens.

Introduction: Urinary tract infection (UTI) is one of the most common childhood bacterial infections, after upper respira- tory tract and middle ear infections1. The true incidence of urinary tract infections in children is difficult to estimate. The risk of developing UTI before the age of 14 years is approximately 1% in boys and 3-5% in girls2. The incidence varies with age. During the first year of life, the male to female ratio is 3-5:1. Beyond 1-2 years, there is female preponderance with male to female ratio of 1:10. Hence the study is taken up to find the clinical profile of UTI in pediatric population. Aims & Objectives: 1.To study clinical manifestations of urinary tract infections in childhood & 2.To study the laboratory profile of urinary tract infections in childhood. Material & methods: This hospital based cross sectional study was conducted in pediatrics department of tertiary care centre from Jan 2013 to June 2015. The study group includes children attending the pediatric OPD and IPD with following inclusion and exclusion criteria. Inclusion criteria: 1. Patient suspected of UTI by positive urinary tract symptoms, signs and/or significant pyuria on urinalysis and later confirmed after admission in pediatric ward in our institution by a positive urine culture. 2. Patients already diagnosed outside for urinary tract infections by positive urine culture and urine analysis admitted in pediatric wards. 3. Age group 1-12 years. Exclusion criteria: 1: Children attending outpatient department only. 2: Age group < 1 years & >12 years. Observation & Results : The study group includes 150 patients who were diagnosed as case of UTI by positive urine culture and satisfying the inclusion criteria. In present study out of 150 children with UTI, 103 were females and 47 were males with male to female ratio of 1:2.2. The largest number of patients 82(54.67%) fell into the 1-5 years age group, followed by 53(35.34%) patients which fell in the 5-10 years age group, 15 (10%) cases fell in 10-12 years age group. The most common symptom in the present study was fever in 107(71.33%) followed by dysuria in 82(54.66%) cases, abdominal pain in 58(38.67%) cases, vomiting in 56(37.34%) cases, frequency of micturition and loss of appetite in 52(34.67 %) cases, irritability in 37(24.67%) cases, chills and rigors in 32(21.34%) cases, decreased urine output in 31(20.67%) cases, passing high coloured urine in 29(19.34%) cases, burning micturition in 20(13.33%) cases, failure to thrive in 14(9.34%) patients ,diarrhea in 11(7.34%) patients, nocturnal enuresis in 10(6.67%) patients, dribbling of urine and foul smelling urine was found in 5(3.34%) patients and hematuria in 2(1.34%) cases. In present study on urine analy- sis, 5 to 10 pus cells/ hpf were found in 44(29.33%) patients, 51(34%) have 10-15 pus cells and plenty of pus cell were present in 55(36.66%) patients. In the present study, commonest organism in urine culture was E. coli in 102(68%) cases followed by klebsiella in 18(12%) patients, Proteus in 7(4.67%) cases, Staphylococcus aureus in 6(4%) patients, Pseudomonas aeruginosa, streptococcus faecalis and enterobacter species were present in 4(2.66%) cases, Acinetobacter species in 3(2%) & Citrobacter and candida albicans were found in 1(0.67%) case. Simple UTI was present in 96(64%) patients, Complicated UTI in 13(8.67%), Recurrent UTI in 22(14.67%) patients & Asymptomatic bacteriuria in 19(12.67%) patients. Conclusion: UTI should be considered as a potential cause of fever in children. As the febrile children with UTI usually present with nonspecific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. Urine microscopy significantly improves the reliability of microscopic urinalysis for detection of UTI for pyuria. However, positive results neither detect all patients with UTI nor the negative test completely rules out infection. Hence, urine culture is the gold standard for diagnosis of UTI in children.