title: Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania.
abstract: BACKGROUND
  Infections are common complications occurring in malnourished childrenas a result of impaired immunity. Urinary tract infections (UTI) have been found to be the commonest cause of fever in normal children in developing countries. However, data regarding UTI among malnourished children is limited because in most of time severe and moderately malnourished children are afebrile despite significant bacteriuria.
  
  
  METHODS
  A total of 402 malnourished underfives were enrolled. Demographic and other clinical characteristics were collected using standardized data collection tool. Urine specimens were cultured and interpreted according to standard operating procedures. Data were analyzed using STATA version 11.
  
  
  RESULTS
  Out of 402 malnourished underfives, 229 (56.9 %) were male. The median age in months was 17 (IQR; 12-31). Of 402 malnourished underfives, 83 (20.3 %) had significant bacteriuria of gram negative enteric bacteria. Escherichia coli 35/84 and Klebsiella pneumonia 20/84 were predominant bacteria isolated. More than 37 % of isolates were resistant to third generation cephalosporins with all of them exhibiting extended spectrum beta lactamase (ESBL) phenotype. Rates of resistance to ampicillin, amoxillin/clavulanic acid, gentamicin and ciprofloxacin were 82/84 (98.7 %), 47/55 (85.4 %), 45/84 (57.8 %) and 9/84 (10.8 %) respectively. Decrease in age and increase in lymphocytes count were independent factors on multivariate logistic regression analysis found to predict UTI (p<0.05).
  
  
  CONCLUSIONS
  Multi-resistant gram negative enteric bacteria are common cause of UTI among underfives. A significant number of severe and moderate malnourished children with bacteriuria had no fever. Therefore, routine testing for UTI is emphasized in all malnourished underfives so that appropriate treatment can be initiated.
authors.affiliation: Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of health and allied sciences, Mwanza, Tanzania. ahmedmaimuna@yahoo.co.uk.
authors.forename: Maimuna
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, P.O.Box 1464, Mwanza, Tanzania. nyamburasogone@gmail.com.
authors.forename: Nyambura
authors.initials: N
authors.lastname: Moremi
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, P.O.Box 1464, Mwanza, Tanzania. mmmirambo@gmail.com.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: Mirambo
authors.affiliation: Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of health and allied sciences, Mwanza, Tanzania. adolfineh@gmail.com.
authors.forename: Adolfine
authors.initials: A
authors.lastname: Hokororo
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, P.O.Box 1464, Mwanza, Tanzania. marthamushi@yahoo.com.
authors.forename: Martha F
authors.initials: MF
authors.lastname: Mushi
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, P.O.Box 1464, Mwanza, Tanzania. senijj80@gmail.com.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Seni
authors.affiliation: Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, Mwanza, Tanzania. Erasmuskamugisha@yahoo.com.
authors.forename: Erasmus
authors.initials: E
authors.lastname: Kamugisha
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of health and allied sciences, P.O.Box 1464, Mwanza, Tanzania. mshana72@yahoo.com.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D018432:Drug Resistance, Multiple; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D013636:Tanzania / Q000453:epidemiology; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents