Background: Urinary tract infection is one of the most common bacterial infection in children. During adolescence, the incidence of UTI increases significantly in young women while remain constant in young men. Asymptomatic bacteriuria is also more common in female. Antibiotic resistance has become an important factor to be considered in the treatment of UTI. There are several risk factors of UTI in both symptomatic and asymptomatic bacteriuria in school going girls in these age group.

Materials & Methods: Midstream urine samples were collected from 200 school going girls of four secondary school spreading in four Thana of Dhaka city by random sampling. Each specimen was cultured on Mac Conkeys and Chromogenic media including microscopic examination. The inoculated plates were incubated at 37^OC aerobically for 24 hours. Antibiotic susceptibility testing of the isolates was also assessed. Risk factors like toilet training (wiping back to front), voiding during school time, incomplete evacuation, constipation, using unhygienic menstrual cloth during menstruation and tight jeans were evaluated.

Results: Prevalence of UTI was 9% of culture positive 18 cases with significant colony count > 10⁵/ml. Among them 4% were symptomatic UTI and 5% were asymptomatic bacteruria. Esch. coli was found to be the most predominant pathogen 44% followed by Klebsiella spp. (17%), Enterobacter spp. (17%), Enterococci spp. (17%) and Proteus spp.(5%). Amoxycillin, cotrimoxazole and cephradine were the common resistant antibacterial agent among isolates. There was significant association of UTI with risk factors like toilet training (wiping back to front), constipation, using unhygienic cloth during menstruation and wearing tight pants (Jeans).

Conclusion: Frequency of UTI was 9% in secondary school going girls. Among them 4% were symptomatic UTI and 5% were asymptomatic bacteriuria. Risk factors like toilet training (wiping from back to front), constipation, unhygienic sanitary cloth during menstruation and using tight jeans pant were associated with UTI. Gram negative bacteria were more common and there were high level of resistance to Amoxycillin, cotrimoxazole and cephradine of the isolated organism.

Keywords: Bacterial pattern, risk factors, UTI, secondary school girls.

1. National Institute for Health & Clinical Excellence (NICE) 2007. Urinary tract infection in children: diagnosis, treatment and long term management. NICE clinical guideline 54 .(available http://www.nice.org.uk/cg054, Retrieved on: 25/02/2012)
2. Tessema B, Kassu A, MuluA,Yismaw G. Predominant isolates of urinary tract pathogens and their antimicrobial susceptibility patterns in Gondar University Teaching Hospital, North West Ethiopia. Ethiop Med J. 2007; 1: 61-67.
3. Hansson SJ, MartinellE,Jodal U. The natural history of bacteriuria in childhood. Infect. Dis. Clin. North Am.1997; 11: 499-512.
4. Dayan PS, Hanson E, Bennett JE, Langsam D, Miller SZ. Clinical course of urinary tract infections in infants younger than 60 days of age. Pediatr. Emerg. Care. 2004; 20: 85-88.
5. Jacobson SH, Eklof O, Eriksson CG, Lins LE, TidgrenB,Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. Br Med J.1989; 299: 703-706.
6. Sreenarasimhaiah S, Hellerstein S.Urinary tract infections per se do not cause end-stage kidney disease. Pediatr Nephrol. 1998; 12: 210-213.
7. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. PediatrInect Dis J. 2008; 27 (4): 302-308.
8. Ahmed SM,Avasarala AK. Urinary tract infection among adolescent girls. Indian J PrevSoc Med.2008; 39 (1 & 2):1133-1140.
9. Singh MM, Devi R, Garg S,Mehra M. Effectiveness of syndromic Approach in Management of reproductive tract infections in women. Indian J. Med Sci. 2001; 55 (4): 209-214.
10. Dulczak SK. Overview of the evaluation, diagnosis and management of urinary tract infection in infants and children. Urologic nursing. 2005; 25(3): 185-191.
11. Smith G. Management of urinary tract infection. Current paediatrics.2004; 14: 556-562.
12. Tanagho E, Jack W. Bacterial infections of genitourinary tract. In: Smith’s General Urology. United States of America: McGraw-Hill Companies Inc; 2004: 203-227.
13. TurckM,Stamm WE. Nosocomial infection of urinary tract. American Journal of Medicine. 1981; 70: 651-654.
14. Paterson A. Urinary tract infection: an update on imaging strategies. EurRadiol. 2004; 14: 89–100.
15. Kumar CSV, Jairam A, Chetan S, Sudesh P, Kapur I, Srikaramallya I. Asymptomatic Bacteriuria in school going children. Indian Journal of Medical Microbiology. 2002; 20 (10): 29-32.
16. Heffner V,Goreick M. Pediatric urinary tract infection. ClinPedEmerg Med. 2008; 9: 223-237.
17. Sahsi RS, Carpenter CR. Does this child have a urinary tract infection? Annals of Emergency Medicine. 2009; 83(5): 680-684.
18. Safarinjad M. Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran Journal of Pediatric Urology. 2007; 3 (6): 443-452.
19. Mazzola BL, VonVigier RO, Marchand S, Tong M,Bianchetti MG. Behavioral and functional abnormalities linked with recurrent urinary tract infection in girls. J. Nephrol. 2003; 16 (1): 133-138.
20. Wan J, Kaplinslay R, Greenfield S. Toilet habits of children evaluated for urinary tract infection. J. Urol. 1995; 154: 797-799.
21. Hoque SA, Islam MT, Ahmed F, Hanif M, Islam S,Matin MA. Impact of constipation in children on urinary tract infection (UTI). Bangladesh J Child Health. 2010; 34 (1): 17-20.
22. Lazarevic G, Petreska D,Pavlovic S. Antibiotic sensitivity of bacteria isolated from the urine of children with urinary tract infections from 1986 to 1995. SrpArhCelokLek. 1998; 126(11-12): 423-429.
23. Alper B, Curry S. Urinary Tract Infection in children. American Family physician. 2005; 72 (12): 2483-2488.
24. Ghazi A. Cotrimoxazole in the empiric treatment of urinary tract infection. Palestinian Medical Journal. 2005;2: 2-5.
25. Al-Mardeni RI, Batarseh A, Omaish L. Empirical treatment for pediatric urinary tract infection and resistance patterns of uropathogens, in Queen Alia hospital and Prince Aisha military center—Jordan. Saudi J Kidney Dis Transpl. 2009; 20(1): 135-139.
26. Ferry S, Burman LG,Mottson B. Urinary tract infection in primary health care in Northern Sweden. II Clinical presentation: Scand J Prime Health Care. 1987; 5 (3): 176-180.
27. Frank PN,Wokoma EC. Prevalence of asymptomatic bacteriuria in students of University of Port Harcourt Demonstration Secondary School. J. Appl. Sci. Environ. Manage. 2009; 13 (2): 55-58.
28. Sawalha RMH. Prevalence of Urinary Tract Infection among Children of Primary School in Nablus. Urinary Tract infections, MPH Thesis. An-Najah National University;2009.
29. Foxman B,Frerichs RR. Epidemiology of urinary tract infection: Diet, clothing and urination habits. Am J Public Health. 1985; 75: 1314-1317.
30. American Academy of Pediatrics. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics. 1999; 103(4): 843–852.
31. Aiyegoro OA, Igbinosa OO, Ogunmwonyi IN. Incidence of urinary tract infection among children and adolescents in IIe-Ife, Nigeria. African Journal of microbiology Research. 2007; 11(2): 013-019.
32. Sakran W, Miron D, Halevy R, Colodner R, SmolkinV,Koren A. Community acquired Urinary Tract Infection among hospitalized children in Israel: pathogens, susceptibility patterns and urinary tract anomalies. Harefuah. 2003;142(4):249-252.
33. McLoughlin TG, Joseph MM. Antibiotic resistance patterns or uropathogens in pediatric emergency department patients. AcadEmerg Med. 2003; 10(4): 347-351.
34. Al-Momani T. Microbiological study of urinary tract infection in children at Princess Haya Hospital in south of Jordan. Middle East Journal of Family Medicine. 2006; 14(2):142-149.
35. Pape L. Bacterial pathogens, resistant patterns and treatment option in community acquired pediatric urinary tract infection. Klinpadiater. 2004; 216(2): 83-88.

Dr. Md. Asaduzzaman

Consultant (Pediatrics), Central Police Hospital Dhaka