ORIGINAL

Niger J Paed 2014; 41 (3):188 –193

Ibeneme CA

Oguonu T

Ikefuna AN

Okafor HU

Ozumba UC

Bacteriology of urinary tract

infection and antimicrobial

sensitivities in under-five children

in Enugu

DOI:http://dx.doi.org/10.4314/njp.v41i3,7

Accepted: 11th February 2014

Abstract: Background: Urinary

the outcome.

tract infection (UTI) is one of the

serious bacterial infections in feb-

rile young children, which may

cause chronic morbidities. Studies

from different parts of Nigeria

have shown varying pattern in its

bacteriology and antibiotic sensi-

tivities. Antimicrobial resistance

rate among uropathogens is an in-

creasing problem limiting thera-

peutic options, and underscores the

need to determine local bacterio-

logical pattern that will guide em-

piric antibiotic choices.

Results: Significant bacteriuria

occurred in 22 (11%) of the 200

samples. Escherichia coli isolates

were the most common organisms

in 7(31.8%) of the 22 positive

samples. Others were Staphylococ-

cus aureus, Klebsiella spp and

Streptococcus faecalis isolated in 5

(

)

Ibeneme CA

Department of Paediatrics,

Federal Medical Centre, Umuahia,

Abia State, Nigeria

E-mail: chik4sco@yahoo.co.uk

Oguonu T, Ikefuna AN, Okafor HU

Department of Paediatrics,

(

22.7%), 3(13.6%), and 3(13.6%)

Ozumba UC

of the positive samples respec-

tively. Most of the isolates were

sensitive to ofloxacin (90.9%),

ciprofloxacin (81.8%), nitrofuran-

toin (77.3%) and ceftriaxone

(72.7%). High levels of resistance

to ampicillin, cotrimoxazole,

amoxicillin, nalidixic acid and

clavulanate-potentiated amoxicil-

lin were observed.

Department of Medical microbiology,

University of Nigeria Teaching

Hospital, Ituku/Ozalla,

Enugu Nigeria

Objectives: To identify the bacte-

rial pathogens responsible for UTI

in febrile under-five children in

Enugu as well as their antibiotic

sensitivity patterns.

Methods: A cross-sectional de-

scriptive hospital based study of

eligible febrile children aged one to

Conclusion: Escherichia coli is the

most common cause of UTI in

febrile under-five children studied.

Ciprofloxacin and ceftriaxone

showed better sensitivities are ad-

vocated for the empiric treatment

of febrile UTI in Enugu.

5

9 months. Urine samples were

collected using mid-stream and

suprapubic aspiration methods.

Standard laboratory procedures

were used to culture the urine

specimens, identify the bacterial

pathogens as well as their antibi-

otic sensitivity patterns. Descrip-

tive statistics were used to analyse

Key words: UTI, under-fives,

bacterial pathogens, antibiotic sen-

sitivities

Introduction

In suspected UTI cases, it is appropriate to begin em-

piric treatment after collecting urine specimensfor cul-

ture and sensitivity. The selection of antibiotics should

be based on, amongst other factors, the pattern of uri-

nary pathogens and their antimicrobial sensitivities in

the local environment. Although Escherichia coli has

been reported to account for most of the cases of symp-

Urinary tract infection is an important cause of morbid-

ity and mortality in the paediatric age group .Sympto-

matic (febrile) UTI is associated with renal parenchymal

involvement which predisposes to renal scarring with

devastating consequences such as hypertension, chronic

1

2

4

renal failure and end-stage renal disease . Delay in initi-

tomatic UTI in children , studies from some parts of

ating appropriate antibiotic therapy during UTI episodes

is a known risk factor for development of renal scars

which is more marked in under-five children . Prompt

diagnosis and early initiation of appropriate antibiotics

in such children would reduce the morbidities associated

with UTI.

Nigeria however, ha_,v₆_,e₇ shown a changing trend in the

5

bacteriology of UTI . While Escherichia coli was the

3

8

most common urinary isolate in studies in Benin and

9

Maiduguri , Klebsiella predominated in studies in Port

5

6

7

Harcourt Ibadan and Abakiliki . Also the antimicrobial

resistance rates among uropatho₇g_,₁e₀_,n₁₁s is on the increase

thus limiting therapeutic options

. The rate and man-

1

89

ner of resistance varies with the setting either in devel-

oping or developed countries. This variation in bacteri-

ology and antibiotic sensitivities warrants different us-

age of antibiotics for empirical treatment of the disease

in various localities to minimize the evolution of bacte-

rial antibiotic resistance and at the same time ensure

adequate and effective treatment. There is no reported

study in Enugu that evaluated urinary tract pathogens

and their antimicrobial sensitivity patterns in children

with symptomatic UTI so as to guide empiric antibiotic

choice and prompt treatment. A study done in Enugu

over two decades ago documented the urinary pathogens

isolated from asymptomatic preschool children . It is

possible there may have been a changing pattern in the

bacteriology of UTI in Enugu over time. Also the bacte-

rial pathogens implicated in asymptomatic UTI may

differ from that of symptomatic UTI. Against this back-

ground, this study was carried out to identify the preva-

lent bacterial pathogens causing UTI in febrile under-

five children seen at UNTH, Enugu as well as the antibi-

otic sensitivity patterns. It is envisaged that the resultant

findings would improve case management of such chil-

dren and perhaps provide basis for the development of

guidelines that could be used in Enugu as well as similar

centres subsequently.

obtained by suprapubic aspiration was considered as

significant bacteriuria . In cases with significant bacteri-

4

uria, the bacterial isolates were identified based on col-

ony morphology characteristics, Gram stain reaction and

1

5

biochemical tests using standard techniques. Antibiotic

sensitivity pattern of the isolates were determined by the

disc diffusion method in accordance with the N₆ational

1

Committee for Clinical Laboratory Standards, using

diagnostic sensitivity test agar (International diagnostic

group PLC, Topley house, Bury Lancashire, BL9 6AU,

UK) and antibiotic multidiscs (Abtek)with the following

antibacterial agents: ampicillin 25mcg, gentamicin

10mcg, nalidixic acid 30mcg, nitrofurantoin 200mcg,

cotrimoxazole 25mcg, amoxicillin 25mcg, augmentin

(amoxicillin-clavulanate) 30mcg, ofloxacin 5mcg. Oth-

ers were ciprofloxacin 5mcg, ceftriaxone, cefuroxime

30mcg, and ceftazidime 30mcg. The discs were placed

onto the agar surface and incubated for 24 hours. After

incubation, the diameter of the zone of inhibition was

measured and compared with a zone diameter interpreta-

tive chart to determine the sensitivity of the isolates to

the antibiotics. Staphylococcus aureus (ATCC 29213)

and Escherichia coli (ATCC 35218) were employed in

the antibiotic sensitivity testing as control.

1

2

The data obtained were analysed using the Statistical

Package for the Soc_®ial Sciences (SPSS) software version

1

5.0 for Windows (SPSS Inc.2006 Chicago, Illinois

Materials and methods

USA). Descriptive statistics was used to describe the

frequency, mean and standard deviation of continuous

variables. Categorical variables were tested for associa-

tion using Pearson Chi square and Fisher exact test as

appropriate. Significant level was set at p value of 0.05.

The study was conducted at the University of Nigeria

Teaching Hospital (UNTH), Enugu, in Nigeria, catering

for patients predominantly from the South-Eastern re-

gion of the country. Ethical approval was obtained from

the hospital’s Health Research and Ethics Committee as

well as caregivers’ written informed consent prior to

subject enrolment. It was a cross-sectional descriptive

study with subjects recruited consecutively from the

Children’s Outpatient Clinic of the hospital between

February and April 2010. Relevant information such as

age, sex, place of domicile, symptoms, past medical and

drug history was obtained. Furthermore, physical exami-

nation to elicit clinical signs of chronic illnesses such as

severe protein energy malnutrition (PEM), sickle cell

disease, malignancies, nephrotic syndrome and HIV/

AIDS were performed before enrolment. Children with

such chronic diseases were excluded as well as those

with history of antibiotic treatment less than seven days

to the study. The urine samples of eligible children were

collected in sterile bottles, containing boric acid, using

suprapubic aspiration in subjects younger than two years

and midstream collection in older children. Urine culture

was done within one hour of collection employing the

quantitative method as described by Guttman and

Results

General characteristics of the study population

One hundred and twelve (56%) of the 200 children en-

rolled were males with a male female ratio of 1.3:1.

Table 1 shows the age and sex distribution of the study

population. The mean age was 31.14 ±17.96 months.The

0

mean temperature was 38.3 ± 0.69 C. Significant bacte-

riuria occurred in 22(11%) of the patients comprising 8

males and 14 females. Females had a higher prevalence

of UTI than males (15.9% [14/88] vs. 7.1% [8/112];

odds ratio [OR] = 2.5 [confidence interval (CI) = 0.9 to

2

6.9] χ = 3.87, P = 0.049). UTI occurred more in infants

compared with non-infants (21.1% [8/38] vs. 8.6%

[14/162]; odds ratio [OR] = 2.8 [confidence interval (CI)

2

= 1.1-7.3] χ = 4.84, P = 0.028)

Table 1: Age and Sex distribution of study population

1

3

Stokes . Each uncentrifuged urine sample was well

mixed and inoculated unto plates of cystine lactose elec-

trolyte deficient (CLED) medium and blood agar as de-

Age group Gender

in months Male Female

12

12-23

24-35

Total (%)

<

23

27

14

25

112

15

17

13

16

27

88

38 (19)

40 (20)

30 (15)

52 (26)

200 (100)

1

4

scribed by Uqurhart and Gould , and incubated aerobi-

0

cally at 37 C for 24 hours after which the colonies were

5

counted with a colony counter. A pure growth of ≥10

colony forming units per ml from midstream urine sam-

ple or growth of any number of uropathogen from urine

3

6-47

4

8-59

All ages

1

90

Isolated Bacterial Pathogens

Antibiotic Sensitivity Pattern of isolated pathogens

Escherichia coli isolates were the most common, grown

in 7(31.81%) of the positive urine cultures. Other patho-

gens isolated were Staphylococcus aureus (22.73%),

Klebsiella species (13.63%) and Streptococcus faecalis

Sensitivity of the bacterial isolates for the respective

antibiotics were ofloxacin (90.9%), ciprofloxacin 81.8%,

nitrofurantoin 77.3%, ceftriaxone 72.7%, gentamicin

63.6%, ceftazidime 50%. Sensitivity was poor to cotri-

moxazole (4.5%), amoxicillin (9.1%), nalidixic acid

(18.2%), cefuroxime (31.8%) and clavulanate potenti-

ated amoxicillin (40.9%). No pathogen was sensitive to

ampicillin. Table 3

(

13.63%). Proteus species, Pseudomonas species, En-

terobacter species and Serratia species each accounted

for 4.55% of the isolates. There were no mixed infec-

tions. Table 2 shows the distribution of the various iso-

lates according to sex.

Table 2: Sex distribution of the isolated pathogens

Bacterial isolates

Males

Females

Total (%)

Escherichia coli

Staphylococcus aureus

Klebsiella spp

Streptococcus faecalis

Proteus spp

Pseudomonas spp

Enterobacter spp

Serratia spp

0

4

2

1

0

7

1

2

0

1

7(31.81)

5(22.73)

3(13.63)

1(4.55)

All pathogens

8

14

22(100.00)

Table 3: Bacterial isolates and their antibiotic sensitivity patterns

Number (%) of Sensitive Bacterial Isolates

Bacterial Isolates OFL

(n)

CIP

NIT

CTZ

GEN

CAZ

AUG

CRX

NA

AMX

COT

AMP

Escherichia coli (7) 7(100)

5(71.4)

5(100)

7(100) 6(85.7) 4(57.1) 4(57.1)

3(42.9)

2(40)

3(42.9)

2(40)

2(28.6)

1(20)

0(0.0)

1(14.3) 0(0.0)

Staphylococcus

aureus (5)

5(100)

3(60)

4(80)

5(100)

1(33.3)

0(0.0)

1(100)

0(0.0)

Klebsiella

spp (3)

Streptococcus

faecalis(3)

2(66.7) 3(100)

2(66.7) 2(66.7)

3(100) 2(66.7) 3(100)

1(33.3)

2(66.7)

0(0.0)

1(100)

0(0.0)

2(66.7)

0(0.0)

1(100)

1(33.3) 0(0.0)

2

(66.7)

0(0.0)

2(66.7) 3(100)

Proteus spp (1)

1(100)

0(0.0)

1(100)

0(0.0)

Pseudomonas spp 1(100)

1)

0(0.0)

1(100)

(

Enterobacter

spp (1)

Serratia spp. (1)

1(100)

20

1(100) 0(0.0)

1(100) 1(100)

All Pathogens (22)

18

17

16

14

11

9

7

4

2

1

0

(90.9)

(81.8)

(77.3)

(72.7)

(63.6)

(50)

(40.9)

(31.8)

(18.2)

(9.1)

(4.5)

(0.0)

OFL= Ofloxacin

CTZ= Ceftriaxone

AUG= Clavulanate potentiated amoxicillin

AMX= Amoxicillin

CIP= Ciprofloxacin

GEN=Gentamicin

CRX= Cefuroxime

COT= Cotrimoxazole

NIT=Nitrofurantoin

CAZ=Ceftazidime

NA=Nalidixicacid

AMP= Ampicillin

8

9

series as was also reported in Benin and Maiduguri,

Klebsiella was the domin₁₇ant organism isolated in studies

5

7

in Portharcourt, Ibadan and Abakiliki . These studies

irrespective of the site have shown the dominance of

gram negative organisms as important causative agents

in urinary tract infections. This reflects the origin of the

bacterial pathogens, which are usually from the micro-

Discussion

The high rate of UTI (11%) in this stu_,d₉y is comparable

8

with the figures documented in studies among children

4

of similar ages in Nigeria.

flora of the intestine, and perineum . The study design

Escherichia coli, Staphylococcus aureus, Klebsiella and

Streptococcus faecalis were the organisms most fre-

quently isolated from the urine samples in our study.

This finding is similar t₇o_,₈_,w₉_,₁h₁a_,₁t₇_,h₁₈ave been documented in

and subject selection used by the different studies may

also be responsible for the differences in the spectr₈um of

uropathogens from these studies. In Benin and

9

Maiduguri as well as in our series children below the

other centres in Nigeria

. However while E. coli

age of five₅years we₁₇re enrolled, wh₇ile the study in

was the most common organism causing UTI in our

Portharcourt, Ibadan and Abakiliki included older

1

91

children above five years of age. In Abakiliki it was a

case series review, which may not have given an exact

representation as some cases may have been excluded.

Some of the children in their study may also have had

other chronic morbidities, which were excluded in our

study. The finding from our study agrees with previous

finding in Enugu that showed E. coli as the most pre-

dominant organism in asymptomatic preschool children.

The similarity of pathogenic agents may suggest that

these organisms, which are present in the genitourinary

tract, become pathogenic given a prevailing circum-

stance. The differences regarding which organism pre-

dominates underscore the need for identifying the organ-

isms responsible for childhood UTI in the local environ-

ment.

Maiduguri where more than 80% of both E. coli and

S.aureus isolates were sensitive to this drug. In Benin

also, comparable sensitivity for this drug was reported

where about 70% and 100% of E. coli and S. aureus

8

isolates respectively were found to be sensitive . The

explanation for the persisting good sensitivity of urinary

isolates to this drug in our environment may be due to

the fact that it is expensive and must be administered

parenterally, therefore less likely to be abused by pa-

tients. This good sensitivity suggests that ceftriaxone

will be safely used in the empiric treatment of febrile

UTI.

Gentamicin was active against 64% of the isolates (57%

of E. coli). The moderate activity of gentamicin against

urinary pathogens in the present study is comparable to

finding in Maiduguri and Ilorin where less t₉h_,₁a₈n 70% of

Escherichia coli infections occurred only in females in

our study and accounted for 50% of all infections in

females. Studies have reported the preponderance of E.

coli infections in females, accou₁n₉t_-i₂n₁ g for 75 to 90% of

E. coli isolates were sensitive to this drug.

Variable

sensitivities of urinary isolates to this drug have been

documented in different centres. Higher sensitivity of

8

all urinary infections in females

. This has been as-

80% was recorded in Benin while_,₁₇studies in Ibadan

6

31

cribed to the proximity of the urethra to the anus in fe-

males which encourages contamination and ascent into

the urinary trac₂₁t of faecal flora of which E. coli is the

most common.

documented very low sensitivities. In South Africa

all gram negative pathogens were 100% sensitive to this

drug. The use of gentamicin in the treatment of UTI

should be considered when it is based on local sensitiv-

ity report.

The large contribution of Staphylococcus aureus as sec-

ond most common causative organism in this₂ study was

Only 41% of the urinary isolates (42.9% of E. coli and

40% of Staph. aureus) were sensitive to clavulanate

potentiated amoxicillin in the present study. This figure

is lower than the 81% sensitivity (50% of E. coli and

2

also demonstrated in other centres. Ibadin in Benin,

2

3

and Adeleke and colleague in Kano documented a high

frequency of S. aureus isolates. These studies however

were among patients with nephrotic syndrome and may

have accounted for the observed trend. In high-income

countries, Escherichia coli constitute a₄h_,₂i₅gh majority (up

8

100% of Staph. aureus) obtained in Benin . However

later studies demonstrated poor sensitivities of 22% and

1

7

9

31% to this drug in Ibadan and in Maiduguri respec-

tively. The increasing resistance of the urinary patho-

gens (especially E. coli) to this drug indicate that clavu-

lanate potentiated amoxicillin may no longer be useful

in the empiric treatment of UTI among children in

Enugu.

2

to 90%) of uropathogens in children . unlike in low-

income countries where other organisms_,₂a₆long with E.

8

Coli contribute largely as urinary isolate, as was dem-

onstrated in our study.

The flouroquinolones showed better sensitivities against

the_,₈_,₉p_,₁₁a_,t₁h₈_,o₂₆g_,₂e₇ns as was observed in other₁₈ studi-

Ampicillin, cotrimoxazole, amoxicillin and nalidixic

acid were the antibiotics with the highest level of resis-

tance noted in this study. Similar₇_,o₉_,b₁₁s_,e₁₇rvation had been

6

11 8

In Maiduguri, Benin and Ilorin, more

es

than 80% of the E. coli isolates was sensitive to cipro-

floxacin. S.₁ aureus was 100% sensitive to this drug in

made by other workers in Nigeria

. The practice of

1

Maiduguri. The higher sensitivity to this class of drugs

self-medication and the possible use of fake and sub-

standard drugs as well as drug abuse may perhaps be

may be attributable to their infrequent use in the treat-

ment of childhood infections. Initially the use of the

flouroquinolones in children was restricted by their po-

tential to induce cartilage toxicity in immature ani-

3

2

responsible for the observed trend . These older drugs

are readily available, accessible and relatively affordable

in patent medicine shops. The oral route of administra-

tion also favours their risk of abuse. With the high level

of resistance to these common antimicrobials observed

in this study, it will be inappropriate to recommend the

use of these older drugs in the empirical treatment of

UTI in this environment.

2

8

mals . Ciprofloxacin however has been found to be

relatively safe in children as no arthropathy has been

2

9

reported . Ciprofloxacin could therefore be safely util-

ized for empirical treatment of febrile UTI in children.

The good sensitivity shown by Nitrofuratoin although

commen₀dable and similar to what was reported by other

3

studies, may not be applicable in practice. The drug is

formulated in tablet form, does not achieve optimal

2

blood levels, and thus is not recommended in those

Conclusions

with renal parenchymal injury.

Escherichia coli is the predominant cause of UTI in feb-

rile under-fives in our series. Ciprofloxacin and ceftri-

axone showed better sensitivities and should be recom-

The good sensitivity of urinary isolates to ceftriaxone in

this study is similar to findings by Mava et al in

1

92

mended for empirical treatment of UTI in under-five

children in Enugu.

Acknowledgements

We acknowledge the invaluable assistance by the resi-

dent doctors and house officers of the Department of

Paediatrics UNTH, Enugu during urine sample collec-

tion. We also thank Mr Francis Aneke, a senior Labora-

tory Scientist in the Department of Microbiology,

UNTH Enugu for his help in analyzing the samples.

Authors’ contribution

ICA: Conception and designing of the study, collecting,

analyzing and interpreting the data, manuscript

writing, revising and approval of the work.

OT: Design of study, manuscript writing, revising, and

approval of the work.

IAN, OHU, OUC: Design of study, manuscript review,

and approval of the work.

Conflict of interest: None

Funding: None

References

1

.

Abdulhadi SK, Yashua AH, Uba

A. Organisms causing urinary tract

infection in paediatric patients at

Muhammad Specialist Hospital,

Kano, Nigeria. Int J Biomed

9. Rabasa AI, Gofama MM. Urinary

17. Brown BJ, Asinobi AO, Fatunde

OJ, Osinusi K, Fasina NA. Antim-

icrobial sensitivity pattern of or-

ganisms causing urinary tract in-

fection in children with sickle cell

anaemia in Ibadan, Nigeria. West

Afr J Med. 2003; 22: 110-13.

18. Adedoyin OT, Oyeyemi BO, Ai-

yedehin OV. Screening of febrile

children on hospital admissions for

Urinary Tract Infections (UTI). Afr

J Clin Exp Microbiol 2003:4(1):56

-62

tract infection in febrile children in

Maiduguri North Eastern Nigeria.

Niger J Clin Pract 2009; 12: 124-

7.

HlthSci 2008; 4: 165-7.

10. Wolff O, Maclenman C. Clinical

review. Evidence behind the WHO

guidelines. Hospital care for chil-

dren: what is the appropriate em-

piric antibiotic therapy in uncom-

plicated urinary tract infections in

children in developing countries? J

Trop Paediatr 2007; 53: 150-2.

11. Mava Y, Bello M, Ambe JP,

Zailani SB. Antimicrobial sensitiv-

ity pattern of organisms causing

urinary tract infection in children

with sickle cell anaemia in

2

.

American Academy of Pediatrics

Practice Parameter: The diagnosis,

treatment and evaluation of the

initial urinary tract infection in

febrile infants and young children.

American Academy of Pediatrics.

Committee on Quality Improve-

ment, SubCommittee on Urinary

Tract Infection. Pediatrics 1999;

19. Modarres S, Oskoii NN. Bacterial

etiologic agents of urinary tract

infections in children in the Islamic

Republic of Iran. East Mediterra-

nean Hlth J 1997; 3: 290-5.

1

03:843-52.

3

.

Christian MT, McColl JH,

MacKenzie JR, Beattie TJ. Risk

assessment of renal cortical scar-

ring with urinary tract infection by

clinical features and ultrasonogra-

phy. Arch Dis Child 2000; 82: 376

Maiduguri, Nigeria. Niger J Clin

Pract 2012; 15:420-3.

20. Hansson S, Jodal U, Noren L,

Bjure J. Untreated bacteriuria in

asymptomatic girls with renal scar-

ring. Pediatrics 1989; 84: 964-8.

21. Elder JS. Urologic Disorders in

Infants and Children. In: Behr-

mann RE, Kliegman RM, Jenson

HB, (eds). Nelson Textbook of

12. Okafor HU, Ibe BC, Njoku-Obi

ANC, Okoro BA. Bacteriology of

asymptomatic bacteriuria in pre-

school children in Enugu. Orient J

Med 2005; 17: 37-42.

13. Guttman DE, Stokes J. Diagnosis

of urinary tract infections: com-

parison of a pour plate method

with a routine method. BMJ 1963;

25: 1384-7.

-80.

4

5

6

.

Srivastara RN, Bagga A. Pediatric

th

Nephrology. 4 edition. Jaypee;

New Delhi: 2005: 235- 64.

th

Eke FU, Eke NN. Renal disorders

in children: A Nigerian study.

Pediatr Nephrol 1994; 8: 383-6.

Adeyemo AA, Gbadegesin RA,

Onyemenem TN, Ekweozor CC.

Urinary tract pathogens and antim-

icrobial sensitivity patterns in

children in Ibadan, Nigeria. Ann

Trop Paediatr 1994; 14: 271-4.

Muoneke VU, Ibekwe MU,

Ibekwe RC. Childhood urinary

tract infection in Abakiliki: Etio-

logical organisms and antibiotic

sensitivity pattern. Ann Med

Health Sci Res 2012; 2:29-32.

Musa-Aissien AS, Ibadin OM,

Ukoh G, Akpede GO. Prevalence

and antimicrobial sensitivity pat-

tern in urinary tract infection in

febrile under-5s at a children’s

emergency unit in Nigeria. Ann

Trop Paediatr 2003; 23: 39-45.

Paediatrics 17 edn. Saunders;

Philadelphia: 2004:1783-1826.

22. Ibadin M. The prevalence of uri-

nary tract infection in children with

nephrotic syndrome. Niger J Pae-

diatr 1997; 24: 40-4.

23. Adeleke SI, Asani MO. Urinary

tract infection in children with

nephrotic syndrome in Kano, Nige-

ria. Ann Afr Med 2009; 8: 38-41.

24. Ginsburg CM, McCracken GH.

Urinary tract infections in young

infants. Pediatrics 1982; 69:409-

12.

25. Shaw KN, Gorelick M, McGowan

KL, Yakscoe NM, Schwartz JS.

Prevalence of urinary tract infec-

tions in febrile young children in

the emergency department. Pediat-

rics 1998[cited 2013 Oct 22];

102:e16. Available from:http://

pediatrics.aappublications.org/

content/102/2/e16.full.html

14. Uqurhart GED, Gould JC. Simpli-

fied technique of counting bacteria

in urine and other fluids. J Clin

Pathol 1965; 18: 480- 2.

15. Murray PR, Baron EO, Pfaller

MA, Jorgensen JH, Yolken RH.

Manual of Clinical Microbiology.

7

.

th

6 edn. ASM Press; Washington

DC: 2003:331- 42.

16. National Committee for Clinical

Laboratory Standards. Perform-

ance Standards for Antimicrobial

8

.

th

Disc Susceptibility Tests. 7 edn.

Approved Standards Document

M2A7. Wayne Pa. USA 2000.

1

93

2

6. Kyabaggu D, Ejobi F, Olila D.

The sensitivities to first-line anti-

biotic therapy of the common

urinary tract bacterial infections

detected in urine samples at a hos-

pital in metropolitan Kampala

29. Dutta S, Chowdhary G, Kumar P,

Mukhopadhay K, Narang A.

Ciprofloxacin administration to

very low birth weight babies has

no effect on linear growth in in-

fancy. J Trop Paediatr 2006; 52:

103-6.

30. Farrell DJ, Morrissey I, De Rubeis

D, Robbins M, Felmingham D. A

UK multicentre study of the an-

timicrobial susceptibility of bacte-

rial pathogens causing urinary

tract infection. J Infect. 2003;46:

94-100.

31. Jeena PM, Coovadia HM, Adhikari

MA. Bacteriuria in children attend-

ing a primary health care clinic: a

prospective study of catheter

stream urine samples. Ann Trop

Paediatr 1996; 16: 293-8.

32. Omolase CO, Adeleke OE, Afolabi

AO, Afolabi OT. Self medication

amongst general outpatients in a

Nigerian community hospital.

Annals of Ibadan Postgraduate

Medicine 2007; 5:64-7

(Uganda). Afr Hlth Sci 2007; 7:

2

14-22.

2

7. Gupta K, Hooton TM, Webbe CL,

Stamm WE. The prevalence of

antimicrobial resistance among

uropathogens causing uncompli-

cated cystitis in young women. Int

J Antimicrob Agents 1999; 11:

3

05-8.

8. Burkhardt JE, Hill MA, Carlton

WW, Kesterson JW. Histologic

and histochemical changes in ar-

ticular cartilages of immature bea-

gle dogs dosed with difloxacin, a

fluoroquinolones. Vet Pathol

1

990; 27: 162-70.