Shahab Modarres and Navideh Nassiri Oskoii
ABSTRACT: The bacterial agents of urinary tract infections were studied in 1650 children under 12 years of age between April 1993 and March 1995. It was found that 25.8% (425/1650) of infants and children showed bacteriuria (>105 bacteria per millilitre of urine). Escherichia coli was responsible for 71.0% of all infections. Infections caused by Proteus spp. were predominantly found in boys. Girls showed a higher prevalence of infection (35.3%) than boys (18.3%), which was statistically highly significant (P < 0.001). The most commonly isolated bacteria were partially or totally sensitive to the aminoglycosides, chloramphenicol and nalidixic acid.
Les agents étiologiques bactériens des infections des voies urinaires chez les enfants en République islamique d'Iran
RESUME: Les agents bactériens des infections des voies urinaires ont été étudiés chez 1650 enfants de moins de 12 ans entre avril 1993 et mars 1995. On a trouvé que 25,8% des nourrissons et des enfants (425/1650) présentaient une bactériurie (>105 bactéries par millilitre d'urine). Escherichia coli était à l'origine de 71% de toutes les infections. Les infections causées par Proteus spp. ont été détectées principalement chez les garçons. Une prévalence plus élevée de l'infection a été observée chez les filles (35,3%) que chez les garçons (18,3%), ce qui est très significatif statistiquement (P<0,001). les bact ries isol es le plus couramment taient soit partiellement totalement sensibles aux aminosides au chloramph nicol et l acide nalidixique p h3 br introduction urinary tract infections utis represent the commonest genitourinary disease in children and are second infection which affects them 1 particularly important because their occurrence may be associated with some congenital abnormality of or an error management if not corrected these lead to recurrent causing damage 2 occur at many places along tract: urethra bladder ureter renal pelvis parenchyma 3 prevalence varies markedly sex age symptomatic about 4 per 1000 newborn infants a slight male preponderance it is assumed that short girls predisposes ascending for example em escherichia coli serotypes from bowel flora same as those infect however factors other than proximity gut likely female ratio directly microbiologically exists when pathogenic microorganisms detected 5 6 considered significant requires treatment more 10 sup millilitre urine present properly collected specimen gram-negative bacteria such e proteus spp klebsiella enterobacter serratia pseudomonas usually especially association stones obstruction urologic manipulation nosocomial catheter-associated 7 microbial sensitivity tests should done first order direct therapy 8 aim study was identify bacterial agents under 12 years resistance antibiotics subjects methods h4 specimens were 1650 suffering who either inpatients outpatients three medical centres teheran between april 1993 march 1995 while patients had symptoms dysuria frequency urgency burning flank pain suprapubic fever haematuria most asymptomatic 40 males 60 females laboratory techniques sterile tubes by standard available transported examination examined within six hours collection stored c 0-4 count will remain unchanged 24-48 9 cells 5ml centrifuged supernatants tipped off deposit resuspended drained back 0 1ml wet film suspension microscopically x40 x100 objectives two white field objective regarded abnormal presence any red culture bacteriological following media inoculated: mcconkey s agar blood nutrient heart infusion broth additional selective inoculated designed participating general cultured onto sheep plates streaked measured drop transversely across all sample incubated 48 37 -10 co sub lower oxidation-reduction potential anaerobic growth identification overnight hand lens also biochemical test using disk diffusion method kirby-bauer counts loop="loop" colony used anichrome internal diameter mm delivery approximately 006 ml inoculation samples technique this inoculating dimensions take up small fixed known volume uncentrifuged spread over plate medium oc 24 number colonies counted estimated calculate viable results total investigated etiologic bacteriuria found 25 common agent 71 isolates both sexes identified causative organism boys against statistically 001 among were: aeruginosa citrobacter salmonella typhi href="/images/stories/emhj/vol3/02/12/32_12f01.gif" target="_blank" table commonly diagnosed 35 18 tables data show majority 2-4 year-old group lowest 10-12 19 isolated sensitive aminoglycosides: tobramycin 67 gentamicin amikacin 47 they 100 resistant vancomycin cloxacillin amoxycillin nalidixic acid figure discussion studies have shown high incidence addition cases result comparable reported others much 11 75 -90 caused followed 1-3 indicates proportions 77 respectively reports indicate higher inhabitant preputial sac vulva its active motility swarming ability can comparison organisms readily traverse longer proportion due encountered -2 school-aged 7-11 beginning schooling young face time errors self-management embarrassment micturating away home made schoolgirls are: clean perineum forwards anus micturate infrequently infrequent micturition leads overdistension subsequent incomplete emptying residual then interferes defences allowing colonization suggested factor prevention proper supervision school lavatories rates groups case-controlled herzog demonstrated significantly uncircumcised without suggest 10-39 times circumcised during year life 13 revealed chloramphenicol aminoglycosides 14 cephalothin acknowledgements we would like thank dr m lessani h falah-shirvani cooperation members department paediatrics loghman-hakim mofid shoorideh providing references ol li feld lg greenfield sp ogra pl pediatrics review 1989 :71-7 naylor gr 16-month analysis journal microbiology 1984 17 :31-6 behrman vaughan nelson textbook vol philadelphia wb saunders company jodal u winberg j unobstructed pediatric nephrology 1987 129 :647-56 travis lb bruhard bh in: rudolph am al eds , 19th ed. Stamford, Appleton and Lange, 1991.
- Tolkoff NE, Rubin RH. Urinary tract infection. Significance and management. Bulletin of the New York Academy of Medicine, 1986, 62(2):131-48.
- Warren JW. Catheter-associated urinary tract infections. Infectious disease clinics of North America, 1987, 1(4):823-54.
- Kunin C. Use of antimicrobial agents in urinary tract infections. Advances in nephrology from the Necker Hospital, 1985, 14:39-65.
- Baron EJ, Finegold SM. Diagnostic microbiology. Textbook for the isolation and identification of pathogenic organisms, 8th ed. St. Louis, Mosby-Year Book Inc., 1990.
- Hansson S et al. Untreated bacteriuria in asymptomatic girls with renal scarring. Pediatrics, 1989, 84(6):964-8.
- Ring E, Zobel G. Urinary infection and malformations of urinary tract in infancy. Archives of disease in childhood, 1988, 63(7):818-20.
- Herzog L. Urinary tract infections and circumcision. A case-control study. American journal of diseases of children, 1989, 143(3):348-50.
- American Academy of Pediatrics: report of the task force on circumcision. Journal of pediatrics, 1989, 84(2):388-91.
- Stamm WE, Turck M. Urinary tract infection and pyelonephritis. In: Braunwald E; ed. Harrison's principles of internal medicine, 12th ed. New York, McGraw-Hill, 1991.
