C MARSHALL 1,2, C PERRY 1, J FRANCIS 2,3, S CHATURVEDI S2,3
1Alice Springs Hospital, Alice Springs, Australia, 2Royal Darwin Hospital, Darwin, Australia, 3Menzies School of Health Research, Darwin, Australia
Aim: To describe the clinical presentation, bacteriology and antibiotic resistance profiles of paediatric urinary tract infection (UTI) in the Top End Health Service (TEHS) of the Northern Territory (NT).
Background: UTI is a common childhood infection. UTI hospitalisations increase with degree of remoteness and socioeconomic disadvantage, with rates in the NT being the highest in Australia. In addition, the NT has one of the highest burdens of chronic kidney disease in the world. Early antimicrobial treatment may reduce the risk of kidney damage from UTI. To our knowledge, there is no published data describing NT-specific paediatric UTI.
Methods: We performed a retrospective audit of culture-proven UTIs in symptomatic children ≤ 16 years presenting to TEHS between 2015-2017. Data relating to clinical presentation, laboratory results, and treatment were extracted from medical records.
Results: There were 546 cases of confirmed UTI with 78.6% occurring in girls, 48.2% in under 2-year-olds and 38.8% among Indigenous children. Indigenous children were more likely to be hospitalised (58.5 vs. 40.1, p < 0.01), have concurrent acute kidney injury (7.5 vs. 3.9, p = 0.06), and have a positive blood culture (12.6 vs. 4.9%, p < 0.05). E. Coli was the most isolated pathogen (84.7%), followed by Klebsiella and Enterococcus. E. Coli had high resistance to ampicillin (>60%), trimethoprim (40%) and co-trimoxazole (>25%).
Conclusions: E.Coli is the most common causative pathogen of paediatric UTIs in the TEHS of NT. There was relatively high resistance to co-trimoxazole, compared to other local guideline first-line antibiotics. Indigenous children were more likely to have complicated infection. This emphasizes the need for improved access to early diagnosis and treatment among Indigenous children.
Carolyn is a final-year Advanced Trainee in General Paediatrics, with particular interest in Aboriginal and Torres Strait Islander health. She has spent the last 4 years in the Northern Territory, working across the Top End and Central Australian Health Services. She has recently commenced postgraduate study in Public Health. She also enjoys baking, sewing, and mountain-biking.