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Children with the cerebral palsy present with lower urinary tract dysfunctions and poor personal hygiene which increases their risk for UTI. As a common infectious cause of morbidity in childhood, UTI may lead to renal scarring, and subsequently hypertension and end-stage kidney disease if it is not appropriately diagnosed and promptly treated.
The study aimed to determine the prevalence, bacterial isolates, antibiotic sensitivity, and predictors of UTI among children with cerebral palsy.
A six months cross-sectional study was conducted in Dodoma City from January to March 2020. Cerebral palsy children who met the inclusion criteria were recruited serially until the desired sample was met. The urine sample was collected using a transurethral catheter (6-12G) or a clean-catch method in two different containers, for urine culture and urine dipstick. Data were analyzed by SPSS version 21, Pearson Chi-square test and logistic regression test were used to reveal the independent predictor of UTI
A total of 131 cerebral palsy children were enrolled, 21(16.03%) had positive urine culture for UTI. Isolate uropathogens were Escherichia coli 15(71.43%), Klebsiella spp 4(19.05%), and Enterococcus spp 2(9.52%). E. coli were the predominant isolate and were 100% resistant to ampicillin, co-trimoxazole, amoxicillin clavam, and cephalexin with intermediate sensitivity to ceftriaxone (46.7%) and gentamycin (40%), and 100% sensitivity to ciprofloxacin, amikacin, and meropenem. Positive urine culture for UTI was strongly predicted by moderate to severe motor dysfunction (AOR 10.18(2.33 –57.61), p= 0.004), intellectual disability (AOR 7.61(1.99 – 29.09), p=0.002), increased urination frequency (AOR 12.18(2.33 –63.61), p= 0.003), history of flank abdominal pain (AOR 5.25(1.07 – 25.76), p=0.041), positive leukocyte esterase (AOR 1.56(1.13 – 5.86), p=0.003) and positive nitrate (AOR 3.59(2.43 – 5.86), p<0.001).
The prevalence and risk of UTI in children with cerebral palsy are significantly high. E. coli was the commonest isolate and resistant to first-line antibiotics. Routine screening for all and early treatment for UTI may be justified in these paediatric patients with identified predictors. However, more prospective case-control studies may be recommended to strengthen the current evidence of the high UTI burden and antibiotic resistance in these patients. |
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