Shila Jalalpour

Molecular Medicine Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

Abstract

Urinary tract infection (UTI) is defined by the presence of a pure growth of more than 10 5colony forming units of bacteria per milliliter of urine. In early childhood, Enterobacteria and Enterococci are part of the normal per urethral flora. Escherichia coli is the dominant gram-negative species in young girls, whereas E. coli and Proteus species predominate in boys. In infants and young children, UTIs may be harder to detect because symptoms are less specific. In fact, fever is sometimes the only sign. Subject of this search was comparative frequency of community acquired urinary tract in Iranian girl children’s during of 2009 and 2010 year. Materials and Methods Urine cultures were routinely obtained on children younger than 10 years of age. Standard quantitative culture was performed by laboratory technologists. Results According to result of 2009 year, from 325 urine sample, frequency of urinary trace infection in girl children was 5.1% and according to result of 2010 year, from 702 urine sample, frequency of urinary trace infection in girl children was 5.3%. Conclusion UTI are a serious health problem affecting millions of people each year. Infections of the UTI are the second most common type of infection in the body. Some things that may help prevent UTIs in child include of: avoid giving your child bubble baths, dress your child in loose-fitting clothing and in girl, teach her to wipe from front to back after she uses the bathroom so that germs from the rectum aren’t wiped into the vagina.

Keywords

Bacteriuria; Girl Children; Escherichia coli; Symptoms

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Copy the following to cite this article: Jalalpour S. Comparative Emergence of Community Acquired Urinary Tract Infection in Iranian Girl Children’s During of 2009 and 2010 Year. Biomed Pharmacol J 2011;4(2)

Copy the following to cite this URL: Jalalpour S. Comparative Emergence of Community Acquired Urinary Tract Infection in Iranian Girl Children’s During of 2009 and 2010 Year. Biomed Pharmacol J 2011;4(2). Available from: http://biomedpharmajournal.org/?p=2149

Introduction

Urinary tract infections (UTIs) are a common type of infection caused by bacteria that travel up the urethra to the bladder. A bladder infection is called cystitis. If bacterial infection spreads to the kidneys and ureters, the condition is called pyelonephritis (Conway  et al.,2007,Foster.,2008, Justice et al.,2006,Nicolle.,2008,U.S.2008). Cystitis is considered a lower urinary tract infection. Pyelonephritis is an upper urinary tract infection and is much more serious. UTI is defined by the presence of a pure growth of more than 10 ⁵ colony forming units of bacteria per millilitre of urine. Lower counts of bacteria may be clinically important, especially in boys, and in specimens obtained by urinary catheter. Any growth of typical urinary pathogens is considered clinically important if obtained by suprapubic aspiration. In practice, three age ranges are usually considered on the basis of differential risk and different approaches to management: children under 1 year; young children (1–4, 5, or 7 years, depending on the information source); and older children (up to 12–16 years). Recurrent UTI is defined as a further infection by a new organism (Conway  et al.,2007,Foster.,2008, Justice et al.,2006, Nicolle., 2008,U.S.2008). Relapsing UTI is defined as a further infection with the same organism. Boys are more susceptible to UTI than girls before the age of 6 months; thereafter, the incidence is substantially higher in girls than in boys (Jakobsson et al.,1999). Estimates of the true incidence of UTI depend on rates of diagnosis and investigation (Jadresic et al.,1993.Jakobsson et al.,1999). The normal urinary tract is sterile. Contamination by bowel flora may result in urinary infection if a virulent organism is involved, or if the child is immunosuppressed. In neonates, infection may originate from other sources. Escherichia coli accounts for about 75% of all pathogens, Proteus is more common in boys (one study found that proteus caused 33% of UTI infections in boys aged 1–16 years, compared with 0% of UTI infections in girls aged 1–16 years). Obstructive anomalies are found in up to 4%, and vesicoureteric reflux in 8% to 40% of children being investigated for their first UTI (Dick et al.,1996). One meta-analysis of 12 cohort studies (537 children admitted to hospital for UTI, 1062 kidneys) found that 36% of all kidneys had parenchymal defects on dimercaptosuccinic acid (DMSA) scintigraphy, and that 59% of children with vesicoureteric reflux on micturating cystourethrography had at least one scarred kidney (pooled positive likelihood ratio 1.96, 95% CI 1.51 to 2.54; pooled negative likelihood ratio 0.71, 95% CI 0.58 to 0.85) (Wennerstrom et al.,2000). There was evidence of heterogeneity in likelihood ratios among studies. The authors concluded that vesicoureteric reflux is a weak predictor of renal damage in children admitted to hospital (Gordon et al.,2003). Thus, although vesicoureteric reflux is a major risk factor for adverse outcome, other factors, some of which have not yet been identified, are also important. Women are more prone to urinary tract infections than men, and these infections tend to recur. One reason is that the urethra (the tube that carries urine away from the bladder) is shorter in women than in men. Contraceptive spermicides and diaphragm use are other risk factors. When women reach menopause, the loss of estrogen thins the lining of the urinary tract, which increases susceptibility to bacterial infections. Pregnancy does not increase the risk of getting a urinary tract infection but it can increase the risk of developing a serious infection that could potentially endanger the mother and fetus (Foster.,2008, Perrotta et al.,2008). Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. A UTI causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just as the inside of the nose or the throat becomes irritated with a cold. In infants or children who are only a few years old, the signs of a UTI may not be clear because children that young cannot express exactly how they feel. Children may have a high fever, be irritable, or not eat. On the other hand, children may have only a low-grade fever; experience nausea, vomiting, and diarrhea; or just not seem healthy (Lin .,2008,Schroeder  et al.,2005,Shaikh et al.,2007,McGillivray et al.,2005,Mori et al.,2007). Children who have a high fever and appear sick for more than a day without signs of a runny nose or other obvious cause for discomfort should be checked for a UTI. Older children with UTIs may complain of pain in the middle and lower abdomen. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of a UTI. Children may leak urine into clothing or bedsheets. If a kidney is infected, children may complain of pain in the back or side below the ribs (Lin .,2008,Schroeder  et al.,2005,Shaikh et al.,2007,McGillivray et al.,2005,Mori et al.,2007). Throughout childhood, the risk of having a UTI is 2 percent for boys and 8 percent for girls. Having an anomaly of the urinary tract, such as urine reflux from the bladder back into the ureters, increases the risk of a UTI. Boys who are younger than 6 months old who are not circumcised are at greater risk for a UTI than circumcised boys the same age.

Some of the urine will be examined with a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. A urine culture should also be performed on some of the urine. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified (Lin .,2008,Schroeder  et al.,2005,Shaikh et al.,2007,McGillivray et al.,2005,Mori et al.,2007). The reliability of the culture depends on how the urine is collected and how long the urine stands before the culture is started. If the urine sample is collected at home, it should be refrigerated as soon as it is collected. The container should be carried to the health care provider or lab in a plastic bag filled with ice. The health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the infection (Lin .,2008,Schroeder  et al.,2005,Shaikh et al.,2007,McGillivray et al.,2005,Mori et al.,2007). Children with recurrent UTIs maybe treated with preventative antibiotics that decrease the rate of microbiological recurrence but not symptomatic recurrence. These conclusion must be viewed in light of the poor quality of evidence available (Smaill.,2007,Michael et al.,2005, Warren et al.,1999, Zalmanovici et al.,2010).

Aims of present study was establish prevalence rates and comparative of urinary tract infection in Iranian girl children’s during of 2009 and 2010 year.

Materials and Methods

Clinical Isolates

A total of 1027 consecutive non-repeat culture isolates of urine cultures were obtained from urine clinical over a period of 24 months (April 2009to December 2010). The isolates were identified on the basis of conventional microbiological procedures (Jalalpoor et al.,2007,2009, Koneman et al.,2006, Washington et al.,2006).

Culture Technique and Definitions

Urine cultures were routinely obtained on children younger than 10 years of age. Urine specimens were then sent to the microbiology laboratory in sterile containers by pneumatic tube. Urine was refrigerated, if not plated, within 10 minutes of receipt. Standard quantitative culture was performed by laboratory technologists (Jalalpoor et al.,2007,2009, Washington et al., 2006).

A loop calibrated to deliver approximately 0.001 mL was used to inoculate blood agar (Merck) and MacConkey (Merck) agar plates. All plates were incubated at 35°C and examined daily for growth for 2 days. A positive result was defined as growth of a single urinary tract pathogen at ≥10⁴ CFU/mL (Kathy etal.,1998).

Figure 1: Multiple rod-shaped bacteria at urinary microscopy Click here to View figure

Results

According to result of this study in  2009 year, from 325 urine sample isolated from community, frequency of urinary trace infection in girl children was 5.1% and according to result of 2010 year, from 702 urine sample isolated from community, frequency of urinary trace infection in girl children was 5.3% (Diag 1).

Diagram 1:  Comparative Frequence of urinary trace infection in girl children’s during of 2009 and 2010 years Click here to View figure

Conclusion

Urinary tract infection (UTI) is one of the most common infections of childhood. It distresses the child, concerns the parents, and may cause permanent kidney damage. Characteristic symptoms of a urinary tract infection include pain with urination (dysuria), urinary frequency (needing to urinate frequently) and urgency (feeling a compelling urge to urinate) and loss of previously established urinary control (for example, bedwetting). Nonspecific but common symptoms include fever (especially >102.2 F or 39 C) and abdominal pain. For some children less than 2 years of age, these more subtle problems may be the only indicator of a UTI. Associated symptoms of concern include flank pain, fever, and vomiting. Obvious blood in the urine (gross hematuria) as well as a positive family history for childhood urinary tract infections (especially in siblings) are also red flags and should raise the level of concern. Interestingly, the odor and color (with the exception of obvious blood) of the urine are not predictors of a UTI (Conway  et al.,2007,Foster.,2008, Justice et al.,2006,Nicolle.,2008,U.S.2008). Bladder infections are most common in young women with 10% of women getting an infection yearly and 60% having an infection at some point in their life (Nicolle,2008). Pyelonephritis occurs between 18–29 times less frequently (Nicolle,2008). According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, urinary tract infection accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations (Epidemiology,2010). Nearly 1 in 3 women will have had at least 1 episode of urinary tract infections requiring antimicrobial therapy by the age of 24 years. The risk of urinary tract infection increases with increasing duration of catheterization. In non-institutionalized elderly populations, urinary tract infections are the second-most-common form of infection, accounting for nearly 25% of all infections (Epidemiology,2010). The condition rarely occurs in men who are younger than 50 years old and who did not undergo any genitourinary procedure. However, the incidence of urinary tract infections in men tends to rise after the age of 50.

According to statistics from 1990, the prevalence of urinary tract infections in pre-school and school girls was 1% to 3%, nearly 30-fold higher than that in boys (The epidemiology,2010). Also, the statistics from the same year show that approximately 5% of girls will develop at least one urinary tract infection in their school years. In what concerns the symptoms of the condition, bacteriuria appears to increase in prevalence with age in women, still being 50 times greater than the one in males. It is estimated that bacteriuria will be experienced by 20 to 50% of older women and 5 to 20% of older men (Gould et al.,2010,Jepson.,2008, Modgil.,2006, Perrotta et al.,2008, Williams et al.,2006). Community studies suggest that boys younger than 1 year of age and girls younger than 5 years of age are most at risk for UTI. The literature estimates that the prevalence of UTI in febrile children presenting for outpatient evaluation ranges from 1% to 20% (Crain et al.,1990, Hoberman et al.,1993, Kathy et al.,1998). Observational studies have found that UTIs have been diagnosed in Sweden in at least 2.2% of boys and 2.1% of girls by age 2 years, (Jakobsson et al.,1999) in 7.8% of girls and 1.7% of boys by age 7 years, (Hellstrom et al.,1991) and in the UK in 11.3% of girls and 3.6% of boys by age 16 years(Coulthard et al.,1997). The studies vary in their definition of UTI, method of urine collection, and eligibility criteria. Most have small sample sizes, and none have been true prevalence studies in which data are collected on all children (Kathy et al.,1998).

References

1. Adult Health Advisor (2005). Bacteria in Urine, No Symptoms (Asymptomatic Bacteriuria) . Archived from the original on 2007-07-12. http://web.archive.org/web/20070712060000/ http://www.med.umich.edu/1libr/aha/aha_asybac_crs.htm. Retrieved 2007-08-25.
2. Benador D, Benador N, Slosman D (1997). Are younger children at highest risk of renal sequelae after pyelonephritis. Lancet 4;349(9044):9-17.
3. Bladder Infections. http://www.livestrong.com/article/12494-bladder-infections/. Retrieved 2010-02-04.Urinary Tract Infections. Available at http://www.medicinenet.com/urine_ infection/page4.htm.
4. Clinical Laboratory Standards Institute (CLSI); Performance standards for antimicrobial disc susceptibility testing. 14 ^th Informational Supplement: 2004.
5. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R (2007). Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 11;298(2):179-186
6. Coulthard MG, Lambert HJ, Keir MJ (1997). Occurrence of renal scars in children after their first referral for urinary tract infection. BMJ 315:918–919.
7. Coulthard MG, Lambert HJ, Keir MJ(2001). DMSAs after UTI: scan more children, not less. Archives of Disease in Childhood 85(4):348.
8. Crain EF, Gershel JC (1990). Urinary tract infections in febrile infants younger than 8 weeks of age. Pediatrics 86:363-367.
9. Dick PT, Feldman W (1996). Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr 128:15-22.
10. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. http://www.ncbi.nlm.nih.gov/pubmed/12601337. Retrieved 2010-06-25.
11. Foster RT (2008). Uncomplicated urinary tract infections in women. Obstet Gynecol Clin North Am 35(2):235-248, viii.
12. Jadresic L, Cartwright K, Cowie N (1993). Investigation of urinary tract infection in childhood. BMJ 307:761-764.
13. Jakobsson B, Esbjorner E, Hansson S (1999). Minimum incidence and diagnostic rate of first urinary tract infection. Pediatrics 104:222-226.
14. Jalalpoor Sh, Kasra Kermanshahi R, Nouhi AS, Zarkesh Esfahani H (2007). Study Production of b-lactamase and Surface layer,Nano Structure in some of Isolated Pathogen Bacteria From Clinical and Environmental Hospital Samples. MSc, Islamic Azad University Science and Research Branch.Iran, Tehran.46-84.
15. Jalalpoor Sh, Kasra Kermanshahi R, Nouhi AS, Zarkesh Esfahani (2009). Comparison of the Frequency β-lactamase Enzyme in Isolated Nosocomial Infectious Bacteria. J Rafsanjan Uni Med Sci 8(3):203-214.
16. Jepson RG, Craig JC (2008). Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev (1): CD001321.
17. Justice S, Hunstad D, Seed P, Hultgren S (2006). Filamentation by Escherichia coli subverts innate defenses during urinary tract infection. Proc Natl Acad Sci USA 103 (52):19884-19889.
18. Hellstrom A, Hanson E, Hansson S (1991). Association between urinary symptoms at 7 years old and previous urinary tract infections. Arch Dis Child 66:232-234.
19. Hoberman A, Han-Pu C, Keller DM, Hickey R, Davis HW, Ellis D (1993). Prevalence of urinary tract infection in febrile infants. J Pediatr 123:17-23
20. Hospital Episode Statistics, The NHS Information Centre (2010); Primary diagnosis: summary 2009-10.
21. Gordon I, Barkovics M, Pindoria S (2003). Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 14:739-744.
22. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Cont Hosp Epidemiol 31(4):319-326.
23. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Win WC, editors (2006). The enterobacteriaceae. In:Color atlas and textbook of diagnostic microbiology, 5 ^th JB Lippincott Co: Philadelphia:211-302.
24. Lin K, Fajardo K (2008). Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 149 (1):W20–4. PMID18591632.
25. McGillivray D, Mok E, Mulrooney E, Kramer (2005). A head-to-head comparison: clean-void bag versus catheter urinalysis in the diagnosis of urinary tract infection in young children. J Pediatr 147(4):451-456.
26. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA (2005). Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Data Sys Review (2):CD003966.
27. Modgil G, Baverstock A (2006). Should bubble baths be avoided in children with urinary tract infections. Arch Dis Child 91(10):863-865.
28. Mori R, Lakhanpaul M, Verrier-Jones K (2007). Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ 25;335(7616):395-397.
29. Nicolle LE (2008). Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am 35(1):1-12.
30. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW (2008). Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev 16;(2):CD005131.
31. Schroeder AR, Newman TB, Wasserman RC, Finch SA, Pantell RH (2005). Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants. Arch Pediatr Adolesc Med 159(10):915-922.
32. Shaw KN, Gorelick M, Karin L (1998). Prevalence of Urinary Tract Infection in Febrile Young Children in the Emergency Department. PEDIATRICS;102(2).
33. Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, DAmico F, et al (2007). Does this child have a urinary tract infection. JAMA 26;298(24):2895-2904.
34. Shaikh N, Morone NE, Bost J, Farrell MH (2008). Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis. Pediatr Infect Dis J 27(4):302-308.
35. Smaill F, Vazquez JC (2007). Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev (2):CD000490. PMID 17443502
36. The epidemiology of urinary tract infection and the concept of significant bacteriuria. http://www.springerlink.com/content/hw6m4w4585746027/. Retrieved 2010-06-25.
37. S. Preventive Services Task Force (2008). Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul 1;149(1):43-7. Ann Intern Med 1;149(1):W20-4.
38. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE (1999). Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 29 (4):745-758.
39. Washington C, Stephen A, Janda W, Koneman E, Procop G,Schreckenberger P, Woods G (2006). Koneman’s Color Atlas and Textbook of Diagnostic Microbiology, Sixth edition.USA: Lippincott wiiliams & wilkins:775-779.
40. Wennerstrom M, Hansson S, Jodal U, Stokland E (2000). Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 136(1):30-34.
41. Williams GJ, Wei L, Lee A, Craig JC (2006). Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev 19;3:CD001534.
42. Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L (2010). Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 10: CD007182.

 

 

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