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Enhanced quantitative urine culture technique, a slight modification, in detecting under-diagnosed pediatric urinary
Januka Thapaliya1, Priyatam Khadka2, Shovana Thapa3
1Tri-Chandra Multiple Campus, Tribhuvan University, Ghantaghar, Kathmandu, Nepal.
Insights
Enhanced quantitative urine culture (EQUC) significantly improves pediatric urinary tract infection (UTI) diagnosis by detecting more pathogens, including resistant strains, compared to standard urine culture (SUC). This method aids in accurate etiology determination and reduces inappropriate antibiotic use.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Diagnostic Techniques
Background:
- Pediatric urinary tract infections (UTIs) are often under-diagnosed due to non-specific symptoms and diagnostic challenges.
- Accurate identification of UTI etiologies is crucial for effective treatment and antimicrobial stewardship.
Purpose of the Study:
- To evaluate the efficacy of the enhanced quantitative urine culture (EQUC) technique in identifying UTI etiologies in children.
- To compare the diagnostic yield of EQUC with standard urine culture (SUC).
Main Methods:
- A study involving 570 pediatric urine samples was conducted.
- Urine samples were analyzed using both EQUC and SUC techniques.
- Detection rates and identification of resistant organisms (MDR, XDR, ESBL) were compared.
Main Results:
- EQUC showed higher significant growth positivity (16.15%) than SUC (12.80%).
- EQUC identified 20.6% more significant isolates missed by SUC, including multidrug-resistant (MDR), extensive drug-resistant (XDR), and extended-spectrum β-lactamase (ESBL) producers.
- E. coli was the most common pathogen, particularly in the 1-4 years age group.
Conclusions:
- EQUC is a superior method for detecting UTI etiologies in children, including challenging resistant strains.
- This improved diagnostic capability can lead to more appropriate antimicrobial prescribing and reduce antibiotic burden.
Objectives:
The pediatric urinary tract infection (UTI) often remains under-diagnosed or neglected owing to non-specific clinical presentations, patients failing to describe the actual situation and of clinical practice in diagnosis. The study was aimed to determine the etiologies of UTI in children with enhanced quantitative urine culture (EQUC) technique.
Results:
Of enrolled 570 pediatric urine samples, the significant growth positivity was higher in EQUC 92 (16.15%) compared to standard urine culture (SUC) 73 (12.80%) technique. 20.6% of the significant isolates as detected with EQUC were missed on the SUC technique. The age group, in range 1-4 years, was more prone to the infection, where E. coli was the commonest pathogen. EQUC detected, probably all isolates, contributing UTI i.e. multidrug-resistant (MDR), extensive drug-resistant (XDR), and extended-spectrum β-lactamase (ESBL) producers, as some of them skipped on the SUC technique. Of total organisms isolated from EQUC, 46% were ESBL producer, 56.5% were MDR, and 1.4% were XDR. However, 40.5% ESBL, 44% MDR but no XDR detected on SUC. Hence a simple modification on conventional culture protocol could be a crucial modification for the detection of etiologies, contributing UTI, and hence to reduce inapt antimicrobial burden.
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