scholarly journals Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

2020 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

2019 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted for fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C)or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results The study included 302 patients of whom 47% presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.


2020 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.


2021 ◽  
Vol 21 (1) ◽  
pp. 214-9
Author(s):  
Ertugrul Guclu ◽  
Fikret Halis ◽  
Elif Kose ◽  
Aziz Ogutlu ◽  
Oğuz Karabay

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guesh Gebremariam ◽  
Haftom Legese ◽  
Yemane Woldu ◽  
Tadele Araya ◽  
Kiflom Hagos ◽  
...  

Abstract Background Bacterial infection of the urinary tract is among the common reasons for seeking medical attention in the community. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Therefore, knowledge of the current uropathogens and their antibiotic susceptibility is important for better treatment of urinary tract infection. Methods A cross-sectional study design was conducted from February to September thirty, 2017 among students who came to Mekelle University student’s clinics with symptomatic urinary tract infection during the study period.. Mid-stream urine specimens were collected from 341individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Data on socio-demographic, clinical and risk factors were also collected using a structured questionnaire. Results Among the 341 study participants, 72(21.1%) showed significant bacteriuria. Escherichia coli (48.6%), Coagulase-negative staphylococci (23%), Staphylococcus aureus (13.5%), and Klebsiella spp. (8.1%) were common bacterial isolates. Resistance to ampicillin (81–100%), amoxicillin/clavulanic acid (77–93.6%), co- trimoxazole (55 72.3%), nalidixic acid (57.4%) and tetracycline (46–55.5%) was seen by most isolates. Multidrug resistance was observed in 73% of the bacterial isolates, and 25.5% of the Gram-negative isolates were extended-spectrum beta-lactamase producers. Being female, a history of urinary tract infection, a history of catheterization and frequent sexual activity were found to be statistically associated with urinary tract infection. Conclusion Urinary tract infection is a problem among university students with a prevalence of 21.1%. All isolates have developed resistance to most of the commonly used antibiotics. Therefore, health education on the transmission and causes of urinary tract infection are recommended for the students.


Author(s):  
Heather Lambert

Vesicoureteric reflux (VUR) describes the flow of urine from the bladder into the upper urinary tract when the ureterovesical junction fails to perform as a one-way valve. Most commonly, VUR is primary, though it can be secondary to bladder outflow obstruction and can occur in several multiorgan congenital disorders. There is good evidence of a genetic basis with a greatly increased risk of VUR in children with a family history of VUR. VUR is a congenital disorder, which largely shows improvement or complete resolution with age. Fetal VUR may be associated with parenchymal developmental defects (dysplasia). Postnatally non-infected, non-obstructed VUR does not appear to have a detrimental effect on the kidneys. However there is an association of VUR with urinary tract infection and acquired renal parenchymal defects (scarring). The parenchymal abnormalities detected on imaging, often termed reflux nephropathy, may be as a result of reflux-associated dysplasia or acquired renal scarring or both. It is difficult to distinguish between the two on routine imaging. Higher grades of VUR are associated with more severe reflux nephropathy. The precise role of VUR in pyelonephritis and scarring is not clear and it may be that VUR simply increases the risk of acute pyelonephritis. Whilst most VUR resolves during childhood, it is associated with an increased risk of urinary tract infection and burden of acute disease. Investigation strategies vary considerably, related to uncertainties about the natural history of the condition and the effectiveness of various interventions. The long-term prognosis is chiefly related to the morbidity of reflux nephropathy leading in some cases to impairment of glomerular filtration rate, hypertension, proteinuria, and pregnancy-related conditions including hypertension, pre-eclampsia, and recurrent urinary tract infection. Management is controversial and ranges from simple observation with or without provision of rapid access to diagnosis and treatment of urinary tract infections; to long-term prophylactic antibiotics or various antireflux surgical procedures.


2017 ◽  
Vol 99 (2) ◽  
pp. 155-160 ◽  
Author(s):  
KV Manley ◽  
R Hubbard ◽  
D Swallow ◽  
W Finch ◽  
SJ Wood ◽  
...  

INTRODUCTION The aim of this study was to investigate the prevalence of risk factors for primary squamous cell carcinoma (SCC) of the bladder. MATERIALS A total of 90 cases of primary SCC of the bladder were identified through multicentre analysis. Patient demographics, stage and grade of cancer at presentation, management and outcomes were recorded. The presence of known risk factors (catheter use, neuropathic bladder, smoking history, recurrent urinary tract infection and bladder stones) was also documented. RESULTS Over half of the patients had at least one identifiable risk factor for the development of primary bladder SCC: 13.9% of patients had a history of catheter use (clean intermittent self-catheterisation [CISC] in 11.1%), 10.0% of patients had a neuropathic bladder, 27.8% were smokers or ex-smokers and 20.0% had a documented history of recurrent urinary tract infection. Statistical analysis of the results showed no association between risk factors and grade of tumour at presentation. CONCLUSIONS These data further support the association between primary bladder SCC and several of the well documented risk factors for its development. Chronic use of CISC may confer a greater risk for development of SCC than thought previously. Further evidence of the role of CISC in primary SCC is required to justify routine screening and to determine exactly when surveillance of the bladder should begin for this group of patients.


Author(s):  
Joan A Casey ◽  
Kara E Rudolph ◽  
Sarah C Robinson ◽  
Katia Bruxvoort ◽  
Eva Raphael ◽  
...  

Abstract Background Urinary tract infection (UTI) accounts for a substantial portion of outpatient visits and antibiotic prescriptions in the United States (US). Few studies have considered sociodemographic factors including low socioeconomic status (SES)–which may increase residential crowding, inappropriate antibiotic prescribing, or co-morbidities–as UTI or multi-drug resistant (MDR) UTI risk factors. Methods We used 2015-2017 electronic health record data from two California healthcare systems to assess whether three sociodemographic factors–use of Medicaid, use of an interpreter, and census tract-level deprivation–were associated with overall UTI or MDR UTI. UTI resistant to ≥3 antibiotic classes were considered MDR. Results Analyses included 601,352 UTI cases, 1,303,455 controls, and 424,977 urinary E. coli isolates from Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. MDR prevalence was 10.4% at KPSC and 12.8% at Sutter Health. All three sociodemographic factors (i.e., use of Medicaid, using an interpreter, and community deprivation) were associated increased risk of MDR UTI. For example, using an interpreter was associated with a 36% (RR = 1.36, 95% CI: 1.31, 1.40) and a 28% (RR = 1.28, 95% CI: 1.22, 1.34) increased risk of MDR UTI at KPSC and Sutter Health, respectively, adjusted for SES and other potential confounding variables. The three sociodemographic factors were only weakly associated with UTI overall. Conclusions We found low SES and use of an interpreter as novel risk factors for MDR UTI in the US.


BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Desie Kasew ◽  
Setegn Eshetie ◽  
Abeje Diress ◽  
Zerubabiel Tegegne ◽  
Feleke Moges

Abstract Background The urinary stone and urinary tract infection (UTI) are invariably associated and are frequent causes of morbidity. Date on burden of UTI among urinary stone patients is lacking in Ethiopia. This study was aimed to assess bacterial profile, antimicrobial susceptibility and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital. Methods An institution based cross sectional study was conducted. Basic sociodemographic data were collected using a structured questionnaire. Bacterial identification of uropathogens and drug susceptibility testing were done following standard microbiological techniques. The data were entered and analyzed using SPSS version-23. Bivariate and multivariate logistic regressions were used to identify possible associated risk factors. Results with P value < 0.05 was considered statistically significant. Result A total of 300 urinary stone patients were enrolled. Of these, 153 (51%) were male and 261(87%) were urban residents. The overall prevalence of urinary tract infection was 49 (16.3%) (95% CI 12–21%). A high level of resistance was observed to ampicillin, penicillin and trimethoprim-sulfamethoxazole while majority of isolates were most sensitive to nitrofurantoin and ciprofloxacin. Multi-drug resistant isolates were 16/49 (32.7%), 75% of them being Enterobacteriaceae isolates. More than one-third 9/26 (34.6%) of Gram-negative isolates were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli and K. pneumoniae. Being female, history of urinary tract infection and history of drug use were the independent risk factors. Conclusion Most of the bacterial isolates from urinary stone patients were resistant to ampicillin, penicillin and trimethoprim-sulfamethoxazole. E. coli and K. pneumoniae were the most common extended spectrum beta-lactamase producing isolates. Sex, history of urinary tract infection and previous drug use were found to be risk factors. Routine diagnosis of urinary stone patients for urinary tract infection should be promoted and further researches are encouraged.


2018 ◽  
Vol 6 (1) ◽  
pp. 204
Author(s):  
Maryam Esteghamati ◽  
Seyedeh Elaheh Mousavi ◽  
Shervin Haj Alizadeh

Background: Urinary tract infection (UTI) is the second most prevalent pediatric infection, and if it is not recognized and treated properly, it can cause severe irreversible complications such as renal failure and hypertension. In this research, some of the risk factors of UTIs were compared in children with urinary tract infections.Methods: This is a cross-sectional study, with the urinary tract infection as the dependent variable and gender, circumcision status, history of urinary catheterization, family history, history of renal stone, hypercalciuria, constipation history, reflux, neurogenic bladder, phimosis, posterior urethral valves (PUV), ureteropelvic junction obstruction (UPJO), and ureterovesical junction obstruction (UVJO) as the independent variables. A total of 405 children were studied in this research. The data was collected using questionnaires, checklists, and examinations. Data analysis was also carried out using descriptive and analytical statistics method in SPSS.Results: This research revealed the prevalence of urinary tract infection among children with several risk factors, and the common factors were positive family history, history of urinary catheterization, constipation, and other non-anatomical disorders (history of renal stone and hypercalciuria. The most common risk factors regardless of gender and age were non-anatomic disorders that were observed in 147 cases (43.7%) (p-value<0.001). Among the non-anatomical factors, constipation was the most common factor observed in 66 cases (16.3%). A higher rate of urinary infection was observed in the uncircumcised male patients than the circumcised patients, and there was a significant relationship between circumcision and UTI.Conclusions: In this study, urinary tract infection staged a significant relationship with gender, circumcision status, urinary catheterization history, family history, renal stone history, hypercalciuria, history of constipation, reflux, neurogenic bladder, phimosis, PUV, UPJO, and UVJO.


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