Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya.
BACKGROUND
The clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood.


METHODS
A cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture.


RESULTS
A total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%).


CONCLUSIONS
Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.
Department of Family Medicine, Webuye Sub-County Hospital, Webuye, Kenya.|Department of Family Medicine, Kabarak University, Kabarak, Kenya.
Wechuli Geoffrey
http://orcid.org/0000-0002-2883-1821
WG
Masika
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.|Duke Global Health Institute, Durham, North Carolina, United States of America.|School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya.
Wendy Prudhomme
WP
O'Meara
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
Thomas L
TL
Holland
Department of Family Medicine, Webuye Sub-County Hospital, Webuye, Kenya.
Janice
J
Armstrong
D001437:Bacteriuria / Q000382:microbiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology