Childhood urinary tract infection: a clinical analysis of 597 cases.
OBJECTIVE
To gain new insights into the epidemiology, genitourinary (GU) tract anomalies, etiologies, susceptibility of urinary pathogens to antibiotics in children with urinary tract infection (UTI) during the past decade in Taiwan.


METHODS
By reviewing medical charts for patients admitted to Kaohsiung Veterans General Hospital between January 1995 and December 2003, we identified and enrolled patients 14 years of age or less admitted due to UTI that was confirmed by positive urine culture.


RESULTS
A total of 597 patients made up our sample. Sixty-eight percent of patients were 1 year old or younger. Boys predominated infant cohort (68.1%). Twenty-seven point one percent of the patients were found in urinalysis to have 5 white blood cells or fewer per high power field and 17.6% had positive nitrite reaction. The pathogens were Escherichia coli, the most common (74.7%), followed by Proteus spp. (6.7%), and Klebsiella spp. (6.4%). E. coli was resistant to ampicillin in 82.0% of the cases, followed by sulfamethoxazole/trimethoprim (55.2%), gentamicin (24.9%), and cefazolin (24%). Resistance to ampicillin and sulfamethoxazole/trimethoprim tended to increase year by year. Forty point seven percent (164/408) of patients had GU tract anomalies, the most common being vesicoureteral reflux (VUR) (87/164, 53.0%). Thirty-three point two percent of the patients with acute pyelonephritis, confirmed by 99mTc dimercaptosuccinic acid (DMSA) renal scan, had VUR.


CONCLUSIONS
Our cohort was predominated by boys, especially in those less than a year old. E. coli, the most common pathogen, had a higher rate of resistance to ampicillin and sulfamethoxazole/ trimethoprim. The pathogens that cause UTI were found to be becoming increasingly resistant to the common antimicrobial agents used in this study. The most common GU tract anomaly was VUR, yet the incidence was lower than that of other reports. A positive DMSA renal scan finding was a good indicator for prediction the possibility of VUR in UTI patients.
Wu
Chan-Yao
CY
Department of Pediatrics, E-DA Hospital/I-Shou University, Kaohsiung County, Taiwan.
Chiu
Pao-Chin
PC
Hsieh
Kai-Sheng
KS
Chiu
Ching-Lan
CL
Shih
Chen-Hung
CH
Chiou
Yee-Hsuan
YH
D000293:Adolescent; D000367:Age Factors; D000583:Amikacin / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003952:Diagnostic Imaging; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D011511:Proteus / Q000187:drug effects / Q000302:isolation & purification; D013420:Sulfamethoxazole / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology; D014551:Urinary Tract / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology
D000890:Anti-Infective Agents; D005839:Gentamicins; D000667:Ampicillin; D000583:Amikacin; D002437:Cefazolin; D013420:Sulfamethoxazole