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| Year : 2010 | Volume
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| Issue : 5 | Page : 961-963 |
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| Urinary tract infection in Iraqi children |
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Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq
Click here for correspondence address and email
| Date of Web Publication | 31-Aug-2010 |
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How to cite this article:
Al-Mendalawi MD. Urinary tract infection in Iraqi children. Saudi J Kidney Dis Transpl 2010;21:961-3 |
To the Editor,
Pediatric urinary tract infection (UTI) accounts for 0.7% of office visits and 5-14% of emergency department visits by children annually, [1] and it has a risk for long-term sequelae including renal scarring, hypertension, and uremia. [2] We retrospectively reviewed the medical records of 146 Iraqi children with culture proven UTI admitted to Al-Khadimyiah Pediatric Hospital, Al-Karama Teaching Hospital/Pediatric Department, and Al-Noor Teaching Hospital/Pediatric Department/Baghdad from the period of 1 st July 2003 to 1 st July 2006. Of 146 patients, 68 (46.4%) were circumcised males and 78 (53.6%) were females with a male to female ratio of 1:1.1 and a mean age of 5.6 ± 3.1 year. Fever occurred in 146 (100%) followed by dysuria in 41 (28.1%), abdominal pain in 32 (21.9%), poor growth in 28 (19.2%), and anorexia and vomiting in 22 (15.1%). Pyuria occurred in 146 (100%) followed by microscopic hematuria in 51 (34.9%), casts in 22 (15.1%), and proteinuria in 9 (6.5%). For the uropathogens isolated by urine culture, E. coli was the commonest in 77 (52.7%) patients and the least was mixed infection (Staph. aureus + Ps. Aeruginosa) in 1 (0.7%). Single antibiotic was used in 107 (73.3%) patients; the most common was cefotaxime 31 (21.2%) and the least was ampicillin 2 (1.4%). Combined antibiotics were used in 39 (26.7%) patients; the most common was ampicillin + gentamicin in 17 (11.6%) and the least was ampicillin + cloxacillin in 9 (6.2%). [Table 1] shows ultrasonographic findings in all the patients. Findings were abnormal in 34 (23.3%) patients including mainly congenital anomalies of urinary tract in 12 (8.2%) and calculi in 9 (6.2%). Intravenous urography (IVU) was done in 9 (6.2%) patients. The findings involved non-functioning kidney, calculi, hydronephrosis, and different congenital anomalies. In contrast, voiding cystourethrography (VCUG) was not done to any patient. The majority of patients 107 (73.3%) stayed in hospital receiving therapy for one to two weeks compared to 29 (19.9%) for < 1week and 10 (6.8%) for > 2 weeks. Recurrent UTI was noticed in 15 (10.3%) patients and none was put on prophylactic antibiotics. Death was stated in 1 (0.7%) patient aged 10 months due to septicemia.
Comments: No statistically significant gender difference was observed in our study, which is probably due to relatively small sample size. However, male predominance during infancy was noted that probably due to lack of circumcision and female preponderance thereafter due to short urethra. [3] Our urinalysis findings are nearly similar to what reported elsewhere. [4],[5],[6] The microbial etiology of UTI is resonably consistent with reports elsewhere. [3],[6],[7] We found 23.3% ultrasonographic changes ranked higher than 15% [8] but less than 37.5% [9] and 62.6% [10] repored previously that probably discloses variations in the skills and experiences of ultrasonographers. A debate has been triggered regarding the optimal time for performing VCUG during or after the infection subsided, therefore, none of our patients had a VCUG during their evaluation. [8] Our hospitalization rate was nearly similar to what reported previously. [4],[5] Recurrent UTI was seen in 10.3% of the studied patients. However, it was reported in 30-50% of cases with predisposing factors including VUR, urinary tract obstruction, voiding dysfunction, and constipation. [9] None of our patients with recurrent UTI received prophylactic antibiotics, since there is still a considerable uncertainty whether long-term, low dose antibiotic adminstration prevents recurrent UTI in children. [10]
Two important limitations exist in our study:
1. The relatively small number of patients enrolled in the study actually does not reflect the actual size of the problem. Indeed, many patients with UTI even those with severe cases sought medical advices on outpatient basis for a variety of reasons rather than being hospitalized and, therefore, were missed and could not be included in the study.
2. The current study dealt retrospectively with many epidemiological, clinical, and laboratory variables that really were not all evaluated in other studies. Therefore, comparing our data with previous ones could not reveal the whole spectra of the problem for wide-base surveillance and renders extracting sharp conclusions questionable.
 Acknowledgment | |  |
Great thanks are due to the demonstrators of the aforementioned hospitals/Baghdad for their kind help in accomplishing the study.
| References | | |
| 1. | Freedman AL. Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children. J Urol 2005;173(3):949-54.  |
| 2. | Eisenhut F, EI-Masri F, Murphy P. Risk factors for renal scarring in children with urinary tract infection: a retrospective case-control study. Arch Dis Child 2003;88(suppl 1):A72-4. |
| 3. | Elder JS. Urinary tract infection. In: Berhman RE, Kliegman RM, Jenson HB, (eds). Nelson Textbook of Pediatrics. 17 th ed; Saunders. International edition. Philadelphia, 2004:178590. |
| 4. | AL-Garibawy SH, Al-Tawil NG. Urinary tract infection among a group of hospitalized children: a clinical and epidemiological study. Iraqi J Med Sci 2001;1(2):169-73. |
| 5. | Frankul FA, Tawaige ZH, AL-Janabi AA. Urinary tract infections in febrile children. J Fac Med (Baghdad) 2003;45(3-4):41-50. |
| 6. | Murad AM, Murad MM, Al-Bayati NM. The prevalence of urinary tract infection in febrile children up to the age of five years. Iraqi J Community Med 2004;17(4):313-5. |
| 7. | Nashat AA, Mohammed NR, AL-Sharik M. Urinary tract infection in groups of Iraqi children. J Fac Med (Baghdad) 2000;42(4):808-12. |
| 8. | Sathapornwajana P, Dissaneewate P, McNeil E, Vachvanichsanong P. Timing of voiding cystourethrogram after urinary tract infection. Arch Dis Child 2008;93(3):229-31. |
| 9. | Mingin GC, Hinds A, Nguyen HT, et al. Children with febrile urinary tract infections and a negative radiologic work-up: factors predictive of recurrence. Urology 2004;63(3):562-5. |
| 10. | Chevalier I, Benoit G, Gauthier M, Phan V, Bonnin AC, Lebel MH. Antibotic prophylaxis for childhood urinary tract infection: a national survey. J Pediatr Child Health 2008;44(10):572-8. |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, P.O. Box 55302, Baghdad
Iraq
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PMID: 20814145 
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