Is there a relationship between urine culture findings and acute phase markers in pediatric patients referring to third level?

Objective (Aim): Urinary system infection is the inflammatory response of the urothelium to microorganisms. It is mostly due to bacterial, to a lesser extent viral or fungal factors. It is one of the most common bacterial infections in childhood. According to a study conducted by Jackson E in 2015, the prevalence of urinary tract infection for children aged 1-18 is 7.8%. The clinic can vary from asymptomatic patient to urosepsis, depending on the severity of the disease, the age of the patient, and the location of the infection. Urine analysis and urine culture should be performed in suspected urinary tract infection. The gold standard for diagnosis is to show the causative microorganism in urine culture. The goals of treatment are to relieve acute symptoms, to prevent serious complications such as urosepsis and renal abscess, to prevent recurrence and long-term complications such as hypertension, renal scar, and renal dysfunction. It is important to choose appropriate antibiotics and to start treatment early for preventing renal damage. Appropriate and narrowest spectrum antibiotic should be selected for treatment. Also local antibiotic resistance patterns should be consider in the selection of antibiotics. The aim of this study is to investigate the relationship between urine culture samples and WBC, CRP, urinalysis test parameters which taken from pediatric patients and to determine the parameter that is more reliable for diagnosis, which will strengthen our hand in places where there is no cultur opportunity. In addition, it was aimed to gain an idea about the regional resistance pattern by evaluating the culture antibiogram and to strengthin our right choices about empirical antibiotics. Material and Method: Our study is a cross-sectional descriptive study. All urine cultures- 2201 samples- requested from the emergency, outpatient clinic, service and intensive care unit of Tokat Gaziosmanpaşa University Department of Pediatrics, between 01.09.2019 and 31.08.2020, were retrospectively analyzed. In the same examination, urine analysis, hemogram, biochemistry and urine culture were requested and the data of pediatric patients aged 0-18 who were able to give their samples on the same day were included in the study. 453 people who were contaminated as a result of culture and those with incomplete data were excluded from the study. Only one urine culture belonging to the same person was included in the study. Repeated arrivals were not included in the study. As a result, the socio-demographic data of 641 patients, patient anamnesis, laboratory results, and prescriptions written to the patients were recorded. G-Power 3.1 ready-made statistics software was used for calculation. While analyzing the data, when p values were calculated less than 0.05, it was considered statistically significant. Results: 451 of 641 patients included in our study were female (70.4%) and 190 (29.4%) were male. 78.75% of 80 people with urine culture reproduction are female and 21.25% of them are male. The most common symptom seen in the patients included in the study and positive urine culture is fever. FMF is the most common accompanying chronic disease in patients with culture reproduction. All urine analysis parameters, except bacteriuria, were found to have a significant relationship with urine culture. The sensitivity of bacteria, leukocyte esterase, leukocyte and nitrite parameters in detecting urinary tract infection, respectively; 91.6; 70.2, 82.6, 33.7 and their specificity is 33.3, 74.5, 61.9, 98.2, respectively. The relation between WBC mean and urine culture was found to be significant. There was a significant relationship between urine density value and urine culture. In the antibiogram, the antibiotics to which E.coli were most sensitive are: imipenem, meropenem, nitrofurantoin, piperacillin-tazobactam. Conclusion: Lack of opportunity to perform urine culture in most family health center in our country, the culture examination is not gives early results, the culture positivity in different laboratories can be at different rates even if the culture is taken, and the families are reluctant to reapply to the hospital during the Covid-19 process cause the need to act with a holistic approach and makes us want to predict the most effective empirical therapy available. But there is no alternative tests to urine culture in the diagnosis of urinary tract infection. However, nitrite positivity is guiding us the diagnosis. The absence of leukocyte esterase or leukocyte is useful in exclusion. İn our city Tokat, cefazolin and cefoxitin for general, in toxic appearance patient amikacin and gentamicin, in patients with lower urinary tract infection nitrofurantoin, fosfomycin may be preferred for empirical treatment, It is recommended to use imipenem, meropenem and piperacillin-tazobactam when needed in a smaller patient group with very poor general condition.