A retrospective study on urinary tract infections in children

A Retrospective Study on Urinary Tract Infections in Children Urinary Tract Infections (UTIs) in children occur very common and can cause serious complications that may yield kidney failure at final stages if it repeated frequently or did not receive adequate treatment. UTIs are very important since these complications can be preventable with early diagnosis and appropriate treatment. In this study 699 patients, who are in the age of 1 month to 18 years old and under monitor due to UTI, are analyzed retrospectively. Seventy-five point eight percent (%75.8) of patients were female, and twenty-four point two (%24.2) were male. The first UTI median age had been found 6 months in males while 18 months in females. First UTI in males had been seen mostly in first 6 months while in females it was between the ages 2 and 5. Most common symptoms were fever, anorexia and vomiting in infants who are younger than 24 months. Pollakuria and enuresis were common symptoms , %42-46, in patients older than 5 years. In 109 patients (15.7%) abnormalities have been observed in their USG. The most common anomaly was hydroneproysis with %49.6. 148 patients (21%) had reflux. Renal scar was detected in 110 patients (15.7 %) among 559 patients who received DMSA. Anomaly in USG, fever, positive CRP, having reflux and degree of reflux were risk factors for renal scar. The most important factor on renal scar was degree of reflux. 442 patients (63.8 %) had recurrence. Recurrences were observed most in the first subsequent year. Patients with recurrence had higher renal scar than the ones without recurrence. It is observed that USG anomaly, having reflux, degree of reflux increases the recurrence. 109 patients had lower urinary tract (LUT) dysfunction. Patients with LUT dysfunction had higher recurrence and hypertension rate than the ones without LUT dysfunction. E coli was the most common microorganism with 82.6%. We found ESBL (+) microorganism in 26 cultures (2.4%). It is observed that ESBL (+) has higher resistance than ESBL (-) and the rate of change in resistance varies between 10%-70% depending on antibiotics. The highest disparity of resistance was found in cephalosporins while the lowest disparity was in piperacillin tazobactam. Resistance to TMP/SMZ for E. coli was 45.6%. Contrary to expectations, resistance significantly decreases over the years (%52.9-%37.9). This decreased can be explained with the usage of antibiotics with wide spectrum like cefixime instead of TMP/SMZ. Resistance against cephalosporins was 18%-20%. Although it was expected to have increase in resistance in recent years due to the frequent use of ceftriaxone and cefepime, there was no significant change over the years. Since there was no a significant increase in resistance to cefixime over the years, cefixime can be still considered to be a good option for oral treatment of community-acquired UTIs. Antibiotic resistance for Pseudomonas was detected high. Resistance was found 70% to TMP/SMZ, 50% to cefepime, cefixime and ceftriaxone, 30% to carbapenems. Pseudomonas showed the lowest resistance to piperacillin tazobactam (10%). There was no increase in resistance to amikacin and ciprofloxacin, however ceftazidime susceptibility had 50% reduction. In recent years with the increase in resistant microorganisms, difficulties in the treatment of UTI are confronted. Therefore treatments should be planned in consideration of regional antibiotic resistance. Thus we should conduct more studies on antibiotics resistance.