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Urinary tract infection (UTI) is a major cause of morbidity and is generally under-reported in children. Children with cerebral palsy (CP) due to motor dysfunction and other risk factors are prone to UTIs. Due to the paucity of studies, establishing etiological agents and antimicrobial sensitivity patterns provides a basis for recommending routine screening of these children for UTI. This single-center matched cross-sectional study compared the prevalence of culture-confirmed UTI between children with CP and apparently healthy controls at the University of Nigeria Teaching Hospital, Enugu. Eighty children with CP were consecutively recruited and matched by age, sex, and socioeconomic status with 80 healthy school children. Urine samples were analyzed using dipstick urinalysis, microscopy, and culture. Associations were assessed using chi-square tests, and predictors were evaluated with logistic regression at a significance level of P < .05. UTI prevalence was 43.8% among subjects compared with 7.5% among controls. Escherichia coli and Klebsiella species accounted for the majority of isolates among subjects and controls (71.4% and 17.1% vs 50% and 33.3%, respectively). The major isolates demonstrated 66.7%-100% sensitivity to quinolones and ceftriaxone. Dipstick urinalysis showed leukocyte esterase in 74.3% of participants with UTIs compared with 8.9% of those without UTIs P < .001; AOR (95% CI) = 29.6 (8.3-106.1). Urine microscopy revealed pyuria in 88.6% of culture-proven UTI cases compared with 17.8% of culture-negative cases P < .001; AOR (95% CI) = 26.2 (7.1-96.6). Escherichia coli and Klebsiella are common causes of UTIs in our environment. Microscopy showed a stronger association with culture-proven UTI than dipstick; further diagnostic accuracy studies are warranted. Treatment of UTIs in children with CP should be guided by urine culture and local antibiogram data, while fluoroquinolones should be reserved for specific indications such as multidrug-resistant infections.
Eze et al. (Sat,) studied this question.