The incidence and causative bacteria of urinary tract infection in children from 2 months to 6 years old in some areas of Hai Phong, Vietnam in 2008

JOURNAL OF SCIENCE, Hue University, N0 61, 2010<br /> <br /> THE INCIDENCE AND CAUSATIVE BACTERIA OF URINARY TRACT<br /> INFECTION IN CHILDREN FROM 2 MONTHS TO 6 YEARS OLD<br /> IN SOME AREAS OF HAI PHONG, VIETNAM IN 2008<br /> Nguyen Ngoc Sang, Dang Van Chuc<br /> Hai Phong Medical University<br /> <br /> SUMMARY<br /> This study was done to assess the incidence of urinary tract infection (UTI) in<br /> children from 2 months to 6 years old in some areas of Haiphong Vietnam, and bacterial<br /> causes and their antibiotic sensitivity on antibiogram from July to October 2007.<br /> Method: This was a cross-sectional study including the screening of clean voiding<br /> midstream samples in the morning for UTI. UTI was defined as the combination of both<br /> leucocyturia (≥ 30/mm3 urine) and bacteriuria (≥ 105/ml urine). Results and<br /> Conclusions: The common incidence rate was 2.8%, UTI affected more girls than boys<br /> (3.3% vs. 2.2%). Causal bacteria was mainly negative gram and E. coli ranks first then<br /> Proteus and Klebsiella. In addition, we found other bacteria such as Enterobacter and<br /> Citrobacter. The bacteria was resistant to oral antibiotics but still sensitive to the third<br /> generation of cephalosporines, amikacines and quinolone group.<br /> Keyword: Urinary Tract Infection in children.<br /> <br /> 1. Introduction<br /> Urinary Tract Infection (UTI) is a disease commonly found in children.<br /> According to the WHO 3-8% of young girls and 1-3.0% of young boys have contracted<br /> UTIs by the age of seven.<br /> UTIs may cause kidney scars (15.1%), which results in dangerous complications<br /> as the child grows older. These include anemia, hypertension (7-17%), prenatal<br /> convulsion, puerperal eclampsia in girls as they grow up, kidney failure and final stage<br /> kidney diseases. UTI causes considerable damage to the economy: The US government<br /> has to spend US$ 1.6 billion per year on UTI. UTI bacteria have grown resistant to<br /> antibiotics at a high level. We posed the questions: What is the rate of UTI researched in<br /> hospitals and in the community?, is UTI bacteria the same as the UTI bacteria in<br /> hospital and what is their sensitivity to antibiotics? In order to answer these questions,<br /> we conducted this study with an aim to identify the UTI incidence among children aged<br /> between two months and six years of age in a number of areas in Haiphong, Vietnam<br /> 385<br /> <br /> and identify the causal bacteria and their sensitivity to antibiotics on an antibiogram.<br /> 2. Methods<br /> 2.1. Subject and research period<br /> - All children between two months and six years of age in a number of areas in<br /> Haiphong Vietnam.<br /> - Research period: July 2007 through October 2007.<br /> - UTI diagnosis criteria: urinary leukocyte ≥ 30/mm3 and urinary bacteria ≥<br /> 105/ml of urine.<br /> 2.2. Methods<br /> - Research area: 3 selected districts, including Kien An (urban), Kien Thuy<br /> (coastal) and Thuy Nguyen (rural). 9 selected wards/ communes include Nam Son,<br /> Trang Minh and Van Dau (Kien An), Dai Ha, Tan Trao and Ngu Doan (Kien Thuy),<br /> Phuc Le, Lap Le and Pha Le (Thuy Nguyen).<br /> - Research design: Cross-sectional study.<br /> - Sample size: calculated with the following formula:<br /> <br /> n  Z 12 <br /> <br /> / 2<br /> <br /> p 1  p <br /> d2<br /> <br /> n: Sample size researched<br /> Z21-α/2 = 1.96 (reliability: 95%)<br /> p = 0.04 ( UTI rate in children in a ward of Hong Bang district, Haiphong,<br /> according to a study conducted by Nguyen Ngoc Sang et al 2005)<br /> d: desired accuracy = (p*)<br />  = 0.2<br /> Applying the formula, we calculated that the number of children to be<br /> researched is around 4610.<br /> - Sampling: Sampling was done with the multi-stage method. In stage 1 districts<br /> were deliberately selected. In stage 2 communes/ wards were randomly selected and in<br /> stage 3 households were randomly selected.<br /> - Data collection: Urine screening includes 3 steps:<br /> Step 1. Urinary leukocyte screening.<br /> A US made 10-parameter urine analyzing machine - Model TC 101-TECO was<br /> used to screen urinary leukocytes. If there are ≥ 30 leukocytes per mm3 then the urine<br /> 386<br /> <br /> sample of this child was transferred in order to cultivate and divide bacteria. Midstream<br /> urine was collected in the morning. The genital area was washed clean with soapy water<br /> the night before and before the urine is obtained.<br /> Step 2. Cultivating urine to identify urinary leukocytes: In accordance with the<br /> process of the World Health Organization to detect and determine the name of bacteria.<br /> Step 3. Make an antibiogram in order to determine the sensitivity of the bacteria<br /> to the antibiotics: according to the Kirby - Bauer method.<br /> - Data processing: SPSS software is used to enter and process the data. Calculate<br /> the percentage, degree of sensitivity, intermediate and resistance of bacteria.<br /> 3. Results<br /> - 4,631 children were urine screened, of whom 2,268 were boys (49%); 2,363<br /> girls (51%); 1,603 rural children (34.6%); 1,568 coastal children (33.9%); 1,460 urban<br /> children (31.5%). There were 618 babies between two and twelve months of age<br /> (13.3%), 1,396 babies were between one and under three years of age (40,9%) and<br /> 2,120 were between 3 and 6 years old (45.8%).<br /> - Genenal UTI rate: 128 out of 4,631 children were found as having both urinary<br /> leukocytes and bacteria in accordance with UTI criteria, accounting for 2.8%, of which<br /> the UTI rate among girls is 79/2,363 (3.3%) and boys is 49/2,268 (2.2%). The UTI rate<br /> among the children aged between 2 months and under one year is 2.8% (17/618), those<br /> aged 1 and under 3 years is 3.2% (61/1893) and those aged between 3 and 6 is 2.4%<br /> (30/2120).<br /> - The bacterium subdivided primarily is E.coli: 59/128 (46.09%), followed by<br /> Proteus: 28/128 (21.87%), Klebsiella: 22/128 (17.18%), Enterobacter 13/128 (10.15%)<br /> and Citrobacter: 6/128 (4.71%).<br /> - The sensitivity of the bacteria to antibiotics on the antibiogram.<br /> Table 1. Sensitivity of E. Coli to antibiotics on the antibiogram (59 samples)<br /> <br /> Resistance (R)<br /> <br /> Intermediate (I)<br /> <br /> Sensitivity (S)<br /> <br /> Antibiotics<br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> Amikacine<br /> <br /> 18<br /> <br /> 30.5<br /> <br /> 4<br /> <br /> 6.8<br /> <br /> 37<br /> <br /> 62.7<br /> <br /> Gentamicine<br /> <br /> 9<br /> <br /> 15.3<br /> <br /> 5<br /> <br /> 8.5<br /> <br /> 45<br /> <br /> 76.3<br /> <br /> Augmentine<br /> <br /> 9<br /> <br /> 15.3<br /> <br /> 16<br /> <br /> 27.1<br /> <br /> 34<br /> <br /> 57.6<br /> <br /> Amoxicilline<br /> <br /> 22<br /> <br /> 37.9<br /> <br /> 2<br /> <br /> 3.4<br /> <br /> 35<br /> <br /> 59.3<br /> <br /> Ampicilline<br /> <br /> 34<br /> <br /> 57.6<br /> <br /> 17<br /> <br /> 28.8<br /> <br /> 8<br /> <br /> 13.6<br /> <br /> 387<br /> <br /> Ceftriaxone<br /> <br /> 13<br /> <br /> 22.4<br /> <br /> 8<br /> <br /> 13.3<br /> <br /> 37<br /> <br /> 63.8<br /> <br /> Cefotaxime<br /> <br /> 9<br /> <br /> 15.3<br /> <br /> 4<br /> <br /> 6.8<br /> <br /> 46<br /> <br /> 78.0<br /> <br /> Nalidixic acid<br /> <br /> 10<br /> <br /> 16.9<br /> <br /> 17<br /> <br /> 28.8<br /> <br /> 32<br /> <br /> 54.2<br /> <br /> Ciprofloxacine<br /> <br /> 15<br /> <br /> 25.4<br /> <br /> 12<br /> <br /> 20.3<br /> <br /> 32<br /> <br /> 54.2<br /> <br /> Co-trimoxazole<br /> <br /> 29<br /> <br /> 49.2<br /> <br /> 10<br /> <br /> 16.9<br /> <br /> 20<br /> <br /> 33.9<br /> <br /> Chloramphenicol<br /> <br /> 30<br /> <br /> 51.7<br /> <br /> 18<br /> <br /> 31.0<br /> <br /> 10<br /> <br /> 17.2<br /> <br /> Remarks: E. coli is resistant to co-trimoxazol 49.2%, ampicilline 57.6%,<br /> chloramphenicol 51.7% but still sensitive to amikacine 62.7%, gentamicine 76,3%,<br /> augmentine 57.6%, amoxicilline 59.3%, ceftriaxone 63.8%, cefotaxime 78%, nalidixic<br /> acid 54.2% and ciprofloxacine 54.2%.<br /> Table 2. Sensitivity of Proteus to antibiotics on the antibiogram (28 samples)<br /> <br /> Resistance<br /> <br /> Intermediate<br /> <br /> Sensitivity<br /> <br /> Antibiotics<br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> Amikacine<br /> <br /> 14<br /> <br /> 50.0<br /> <br /> 2<br /> <br /> 7.1<br /> <br /> 12<br /> <br /> 42.9<br /> <br /> Gentamicine<br /> <br /> 9<br /> <br /> 32.1<br /> <br /> 3<br /> <br /> 10.7<br /> <br /> 16<br /> <br /> 57.1<br /> <br /> Augmentine<br /> <br /> 2<br /> <br /> 7.1<br /> <br /> 5<br /> <br /> 17.9<br /> <br /> 21<br /> <br /> 75.0<br /> <br /> Amoxicilline<br /> <br /> 6<br /> <br /> 21.4<br /> <br /> 2<br /> <br /> 7.1<br /> <br /> 20<br /> <br /> 71.4<br /> <br /> Ampicilline<br /> <br /> 16<br /> <br /> 57.1<br /> <br /> 9<br /> <br /> 32.1<br /> <br /> 3<br /> <br /> 10.7<br /> <br /> Ceftriaxone<br /> <br /> 11<br /> <br /> 39.3<br /> <br /> 7<br /> <br /> 25.0<br /> <br /> 10<br /> <br /> 35.7<br /> <br /> Cefotaxime<br /> <br /> 3<br /> <br /> 10.7<br /> <br /> 0<br /> <br /> 0.0<br /> <br /> 25<br /> <br /> 89.3<br /> <br /> Nalidixic acid<br /> <br /> 6<br /> <br /> 21.4<br /> <br /> 5<br /> <br /> 17.9<br /> <br /> 17<br /> <br /> 60.7<br /> <br /> Ciprofloxacin<br /> <br /> 4<br /> <br /> 14.3<br /> <br /> 9<br /> <br /> 32.1<br /> <br /> 15<br /> <br /> 53.6<br /> <br /> Co-trimoxazole<br /> <br /> 16<br /> <br /> 57.1<br /> <br /> 7<br /> <br /> 25.0<br /> <br /> 5<br /> <br /> 17.9<br /> <br /> Chloramphenicol<br /> <br /> 15<br /> <br /> 53.6<br /> <br /> 11<br /> <br /> 39.3<br /> <br /> 2<br /> <br /> 7.1<br /> <br /> Remarks: Proteus is sensitive to amoxicilline 71.4%, augmentine 75%,<br /> gentamicine 57.1%, cefotaxime 89.3%, nalidixic acid 60.7% and ciprofloxacine 53.6%<br /> but is resistant to amikacine 50%, co-trimoxazol 57.1%, ampicilline 57.1% and<br /> chloramphenicol 53.6%.<br /> <br /> 388<br /> <br /> Table 3. Sensitivity of Klebsiella to antibiotics on the antibiogram (22 samples).<br /> <br /> Resistance<br /> <br /> Intermediate<br /> <br /> Sensitivity<br /> <br /> Antibiotics<br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> Amikacine<br /> <br /> 11<br /> <br /> 50.0<br /> <br /> 4<br /> <br /> 18.2<br /> <br /> 7<br /> <br /> 31.8<br /> <br /> Gentamicine<br /> <br /> 5<br /> <br /> 22.7<br /> <br /> 4<br /> <br /> 18.2<br /> <br /> 13<br /> <br /> 59.1<br /> <br /> Augmentine<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> 18<br /> <br /> 81.8<br /> <br /> Amoxicilline<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> 1<br /> <br /> 4.5<br /> <br /> 19<br /> <br /> 86.4<br /> <br /> Ampicilline<br /> <br /> 12<br /> <br /> 54.5<br /> <br /> 9<br /> <br /> 40.9<br /> <br /> 1<br /> <br /> 4.5<br /> <br /> Ceftriaxone<br /> <br /> 4<br /> <br /> 18.2<br /> <br /> 7<br /> <br /> 31.8<br /> <br /> 11<br /> <br /> 50.0<br /> <br /> Cefotaxime<br /> <br /> 0<br /> <br /> 0.0<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> 20<br /> <br /> 90.9<br /> <br /> Nalidixic acid<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> 3<br /> <br /> 13.6<br /> <br /> 17<br /> <br /> 77.3<br /> <br /> Ciprofloxacine<br /> <br /> 5<br /> <br /> 22.7<br /> <br /> 6<br /> <br /> 27.3<br /> <br /> 11<br /> <br /> 50.0<br /> <br /> Co-trimoxazole<br /> <br /> 16<br /> <br /> 57.1<br /> <br /> 7<br /> <br /> 25.0<br /> <br /> 5<br /> <br /> 17.9<br /> <br /> Chloramphenicol<br /> <br /> 10<br /> <br /> 45.5<br /> <br /> 10<br /> <br /> 45.5<br /> <br /> 2<br /> <br /> 9.1<br /> <br /> Remarks: Klebsiella is resistant to amikacine 50%, co-trimoxazole 57.1%,<br /> ampicilline 54.5%, and chloramphenicol 45.5% but is still sensitive to augmentine<br /> 81.1%, amoxicilline 86.4%, gentamicine 59.1%, ceftriaxone 50%, cefotaxime 90.9%,<br /> nalidixic acid 77.3% and ciprofloxacine 50%.<br /> Table 4. Sensitivity of Enterobacter to antibiotics on the antibiogram (13 samples)<br /> <br /> Resistance<br /> <br /> Intermediate<br /> <br /> Sensitivity<br /> <br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> n<br /> <br /> Rate %<br /> <br /> Amikacine<br /> <br /> 2<br /> <br /> 15.4<br /> <br /> 1<br /> <br /> 7.7<br /> <br /> 10<br /> <br /> 76.9<br /> <br /> Gentamicine<br /> <br /> 5<br /> <br /> 38.5<br /> <br /> 2<br /> <br /> 15.4<br /> <br /> 6<br /> <br /> 46.2<br /> <br /> Augmentine<br /> <br /> 5<br /> <br /> 38.5<br /> <br /> 1<br /> <br /> 7.7<br /> <br /> 7<br /> <br /> 53.8<br /> <br /> Amoxicilline<br /> <br /> 7<br /> <br /> 53.8<br /> <br /> 0<br /> <br /> 0.0<br /> <br /> 6<br /> <br /> 46.2<br /> <br /> Ampicilline<br /> <br /> 11<br /> <br /> 84.6<br /> <br /> 2<br /> <br /> 15.4<br /> <br /> 0<br /> <br /> 0.0<br /> <br /> Ceftriaxone<br /> <br /> 4<br /> <br /> 30.8<br /> <br /> 5<br /> <br /> 38.5<br /> <br /> 4<br /> <br /> 30.8<br /> <br /> Cefotaxime<br /> <br /> 4<br /> <br /> 30.8<br /> <br /> 1<br /> <br /> 7.7<br /> <br /> 8<br /> <br /> 61.3<br /> <br /> Nalidixic acid<br /> <br /> 4<br /> <br /> 30.8<br /> <br /> 4<br /> <br /> 30.8<br /> <br /> 5<br /> <br /> 38.5<br /> <br /> Antibiotics<br /> <br /> 389<br /> <br />