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Published on: February 9, 2011
Paediatric nosocomial urinary tract infection at a regional hospital
F A Orrett1, P J Brooks, E G Richardson
1Department of Microbiology/Pathology, Faculty of Medical Sciences, The University of the West Indies, Republic of Trinidad and Tobago.
Insights
Paediatric nosocomial urinary tract infections (PNUTI) are common in catheterized children, especially in the nursery. Escherichia coli and Klebsiella spp. were frequent pathogens, with specific antibiotic sensitivities noted.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hospital Epidemiology
Background:
- Nosocomial urinary tract infections (UTIs) are a significant concern in hospitalized children.
- Understanding the epidemiology and causative agents of paediatric nosocomial UTIs (PNUTI) is crucial for effective prevention and treatment.
Purpose of the Study:
- To investigate the incidence, causative pathogens, and antibiotic susceptibility patterns of PNUTI.
- To identify high-risk patient populations and hospital services for PNUTI.
Main Methods:
- Retrospective chart review of 26,603 paediatric admissions over 5 years.
- Analysis of 1360 identified cases of PNUTI, including patient demographics, affected services, and microbial isolates.
- Evaluation of antibiotic effectiveness against isolated pathogens.
Main Results:
- PNUTI incidence was highest in the nursery (11.28/100 admissions), followed by paediatric surgery (2.89) and medicine (2.86).
- Approximately 90% of PNUTIs occurred in catheterized patients.
- Escherichia coli, Proteus mirabilis, and Klebsiella spp. were the most common pathogens, with varying prevalence across services. Proteus mirabilis was linked to boys with urethral abnormalities.
- Nalidixic acid, gentamicin, and amoxicillin-clavulanic acid demonstrated the highest effectiveness against UTIs.
Conclusions:
- Catheterization is a primary risk factor for PNUTI in children.
- Specific pathogens dominate in different paediatric services, necessitating targeted antimicrobial strategies.
- Effective antibiotic choices for PNUTI include nalidixic acid, gentamicin, and amoxicillin-clavulanic acid.
Abstract:
From a total of 26,603 admissions to the paediatric wards, 1360 paediatric nosocomial urinary tract infections (PNUTI) were identified during a 5-year retrospective chart review at the SFGH. The ages ranged from 3 days to 13 years, with 46% boys and 54% girls. The highest rates of PNUTI per service per 100 admissions were seen in the nursery (11.28) followed by paediatric surgery (2.89) and paediatric medicine (2.86). Although the greatest number of PNUTI occurred in the nursery, comparison between the years was not statistically significant. About 90% (1218 of 1360) of PNUTI occurred in catheterized patients. No documentation was found specifying the type of catheterization (intermittent or continuous). About 90% (1210 of 1360) of isolates were single organisms with Escherichia coli, Proteus mirabilis, Klebsiella spp. and Group B streptococci accounting for a total of approximately 70% of all pathogens. However, the composition of the most common isolate in each service differed. The most common isolate in the nursery was E. coli, in the paediatric medical and surgical services the most common isolates were Klebsiella spp. and Proteus mirabilis, respectively. Proteus mirabilis was isolated predominantly from boys with structural abnormality of the urethral tract. No PNUTIs were complicated by bacteraemia. The antibiotics with least effectiveness (in increasing order) for UTIs were cephalexin, ampicillin, trimethoprim, co-trimoxazole and tetracycline. The most effective antibiotics were nalidixic acid, gentamicin and amoxicillin-clavulanic acid.
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