Experience with point-of-care urine culture in children at Rahima Moosa Mother & Child Hospital, Johannesburg, South Africa
Date
2015-09-07
Authors
Migambi, Ismail
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Abstract
Urinary tract infections (UTIs) are an important cause of morbidity in
children in developing countries and increasing antimicrobial resistance is reported in many
countries. This retrospective study describes the performance of urine dipsticks, the aetiology
and the antimicrobial susceptibility of paediatric UTIs at Rahima Moosa Mother and Child
Hospital, Johannesburg.
METHODS: We conducted a retrospective study of results from patients investigated for
UTI over a four year period between January 2009 and December 2012 in the Department of
Paediatrics & Child Health at Rahima Moosa Mother and Child Hospital.
RESULTS: Escherichia coli was the commonest isolated uropathogen. Dipsticks sensitivity
to identify UTI was 40% for leucocyte esterase and 34% for nitrites. The specificity was
94.6% for leucocyte esterase and 96% for nitrites. Malnutrition was associated with greater
risk of having a UTI, with odds ratio of 2.06 (95% Confidence interval 1.4-2.9). In addition
malnourished children tended to present with more resistant uropathogens. Resistance to
sulphamethoxasole/trimethoprim and cephalexin has been progressively increasing between
2009 and 2012. From 64% to 79% for sulphamethoxasole/trimethoprim and from 24% to
63% for cephalexin.
CONCLUSION: Positive urine dipsticks results allow immediate patient treatment but
negative results need to be interpreted within the clinical context due to a high rate of false
negatives. Malnourished children are significantly predisposed to urinary tract infections and
tend to have more resistant uropathogens. Resistance to cephalexin is rising and studies to
assess patient outcomes are needed to determine whether cephalexin still has a role in the
treatment of paediatric UTI.
Description
Research report submitted in partial fulfilment of the requirements for the degree of Master of
Medicine in Paediatrics.
Johannesburg, 2015.