A STUDY OF URINARY TRACT INFECTION IN CHILDRENS UNDER FIVE YEARS IN KARBLA

A study of urinary tract infection in childrens under 5years had been planned to identify the bacterial causes ,antibiotics sensitivity results and also immunological response to these bacteria .This study extend from 1/12/2004 to 1/12/2005 in pediatric hospital in Karbala .The methods of investigation used in this study were the standard criteria for urinalysis to look for puree which mean presence of more than 5 pus cells in centrifuged urine in high power field (WHO,2001) ,Also the color, cloudiness ,acidity of urine were registered for each sample . A urine culture was performed to detect the presence of any types of bacteria as well as their antibiotic sensitivity test were performed .The specific immunological response to bacterial types were assessed by immunodiffusion test . The standard criteria of this study were the age range from birth to five years, sex, previous urinary tract infection in the child, residence, type of feeding, chief complaint of child, congenital abnormalities if present, and past medical history of child. The total randomly selected cases in this study were 385 childrens (156 boys and 229 girls), Pyuria were diagnosed in 100 cases of them .they were 37 boys and 63 girls . 56 positive urine cultures for boys and girls of which 21(13.5%) from 156 cases for boys and the results for girls were 35(15.3%) from 229 cases .The numbers of positive urine cultures for E .coli were 37(66%),10(18%) for Proteus, 3(5.4%) Klebsiella, 1(1.8%) Pseudomonas,4(7.1%) Staphylococcus saprophyticus ,1(1.8%) for Enterobacter . in 44 cultures we couldn't isolate any bacteria although the cultures incubated for more than 48 hours , 20 culture for boys and 24 for girls and considered negative due to the use of antibiotics. E .coli susceptibility to antibiotics was characterized by high resistance to amoxicillin,cotrimaxazole, and where considered susceptible to nitrofurantoin, nalidixic acid , cefotaxime, gentamicin. The high resistance among Klebsiella pneumonia also toward amoxicillin and for cefotaxime, where considered susceptible toward nitrofurantoin , cotrimaxazole . The high resistance of proteus toward amoxicillin and sensitive for nalidixic acid and cefotaxime. The sensitive antibiotics of Staphylococcus saprophyticus were for cefotaxime, nalidixic acid , nitrofurantoin . The sensitive antibiotics of Pseudomonas and for Enterobacter were for cefotaxime and nitrofurantoin. The results of immunological response to E. coli show (2792.5 mg/dl) IgG antibodies which represent chronic infection and (318.5 mg/dl) IgM antibodies which represent acute infection However with proteus show (2439.6 mg/dl) anti proteus IgG antibodiesand only(66.8 mg/dl) IgM anti proteus antibodies. And for cases of pyuria with negative cultures show (1448 mg/dl) IgG antibodies and (16.8 mg/dl) IgM antibodies .So in general the immunological response for E. coli was higher than Proteus which was higher than pyuria cases with negative cultures .