385
JOURNAL OF SCIENCE, Hue University, N
0
61, 2010 THE INCIDENCE AND CAUSATIVE BACTERIA OF URINARY TRACT
INFECTION IN CHILDREN FROM 2 MONTHS TO 6 YEARS OLD
IN SOME AREAS OF HAI PHONG, VIETNAM IN 2008
Nguyen Ngoc Sang, Dang Van Chuc
Hai Phong Medical University
SUMMARY
This study was done to assess the incidence of urinary tract infection (UTI) in
children from 2 months to 6 years old in some areas of Haiphong Vietnam, and bacterial
causes and their antibiotic sensitivity on antibiogram from July to October 2007.
Method: This was a cross-sectional study including the screening of clean voiding
midstream samples in the morning for UTI. UTI was defined as the combination of both
leucocyturia (≥ 30/mm
3
urine) and bacteriuria (≥ 10
5
/ml urine). Results and
Conclusions: The common incidence rate was 2.8%, UTI affected more girls than boys
(3.3% vs. 2.2%). Causal bacteria was mainly negative gram and E. coli ranks first then
Proteus and Klebsiella. In addition, we found other bacteria such as Enterobacter and
Citrobacter. The bacteria was resistant to oral antibiotics but still sensitive to the third
generation of cephalosporines, amikacines and quinolone group.
Keyword: Urinary Tract Infection in children.


- Research area: 3 selected districts, including Kien An (urban), Kien Thuy
(coastal) and Thuy Nguyen (rural). 9 selected wards/ communes include Nam Son,
Trang Minh and Van Dau (Kien An), Dai Ha, Tan Trao and Ngu Doan (Kien Thuy),
Phuc Le, Lap Le and Pha Le (Thuy Nguyen).
- Research design: Cross-sectional study.
- Sample size: calculated with the following formula:


2
2
2/1
1
d
pp
Zn





n: Sample size researched
Z
2
1-α/2
= 1.96 (reliability: 95%)
p = 0.04 ( UTI rate in children in a ward of Hong Bang district, Haiphong,
according to a study conducted by Nguyen Ngoc Sang et al 2005)
d: desired accuracy = (p*)
 = 0.2
Applying the formula, we calculated that the number of children to be

the UTI rate among girls is 79/2,363 (3.3%) and boys is 49/2,268 (2.2%). The UTI rate
among the children aged between 2 months and under one year is 2.8% (17/618), those
aged 1 and under 3 years is 3.2% (61/1893) and those aged between 3 and 6 is 2.4%
(30/2120).
- The bacterium subdivided primarily is E.coli: 59/128 (46.09%), followed by
Proteus: 28/128 (21.87%), Klebsiella: 22/128 (17.18%), Enterobacter 13/128 (10.15%)
and Citrobacter: 6/128 (4.71%).
- The sensitivity of the bacteria to antibiotics on the antibiogram.
Table 1. Sensitivity of E. Coli to antibiotics on the antibiogram (59 samples)
Antibiotics
Resistance (R) Intermediate (I) Sensitivity (S)
n Rate % n Rate % n Rate %
Amikacine 18 30.5 4 6.8 37 62.7
Gentamicine 9 15.3 5 8.5 45 76.3
Augmentine 9 15.3 16 27.1 34 57.6
Amoxicilline 22 37.9 2 3.4 35 59.3
Ampicilline 34 57.6 17 28.8 8 13.6 388
Ceftriaxone 13 22.4 8 13.3 37 63.8
Cefotaxime 9 15.3 4 6.8 46 78.0
Nalidixic acid 10 16.9 17 28.8 32 54.2
Ciprofloxacine 15 25.4 12 20.3 32 54.2
Co-trimoxazole 29 49.2 10 16.9 20 33.9
Chloramphenicol 30 51.7 18 31.0 10 17.2
Remarks: E. coli is resistant to co-trimoxazol 49.2%, ampicilline 57.6%,
chloramphenicol 51.7% but still sensitive to amikacine 62.7%, gentamicine 76,3%,
augmentine 57.6%, amoxicilline 59.3%, ceftriaxone 63.8%, cefotaxime 78%, nalidixic
acid 54.2% and ciprofloxacine 54.2%.

Ampicilline 12 54.5 9 40.9 1 4.5
Ceftriaxone 4 18.2 7 31.8 11 50.0
Cefotaxime 0 0.0 2 9.1 20 90.9
Nalidixic acid 2 9.1 3 13.6 17 77.3
Ciprofloxacine 5 22.7 6 27.3 11 50.0
Co-trimoxazole 16 57.1 7 25.0 5 17.9
Chloramphenicol 10 45.5 10 45.5 2 9.1
Remarks: Klebsiella is resistant to amikacine 50%, co-trimoxazole 57.1%,
ampicilline 54.5%, and chloramphenicol 45.5% but is still sensitive to augmentine
81.1%, amoxicilline 86.4%, gentamicine 59.1%, ceftriaxone 50%, cefotaxime 90.9%,
nalidixic acid 77.3% and ciprofloxacine 50%.
Table 4. Sensitivity of Enterobacter to antibiotics on the antibiogram (13 samples)
Antibiotics
Resistance Intermediate Sensitivity
n Rate %

n Rate %

n Rate %
Amikacine 2 15.4 1 7.7 10 76.9
Gentamicine 5 38.5 2 15.4 6 46.2
Augmentine 5 38.5 1 7.7 7 53.8
Amoxicilline 7 53.8 0 0.0 6 46.2
Ampicilline 11 84.6 2 15.4 0 0.0
Ceftriaxone 4 30.8 5 38.5 4 30.8
Cefotaxime 4 30.8 1 7.7 8 61.3
Nalidixic acid 4 30.8 4 30.8 5 38.5 390

4. Discussions
UTI rate among children aged between two months and six years in some areas
of Haiphong is 2.8%. This findings conform to that by Steven 2.8-4.2%, bigger than that
of Gram1.2% and Kikuo 0.28%.
By gender, we found that UTI rate in boys (2.2%) is lower than that in girls
(3.3%), a statistical difference. This findings are closer to those found in the study by 391
Gal, Steven and WHO : 1-3% boys and 6-8% girls contracted UTI respectively.
We found a distinct difference in UTI rate in the three age groups: 2 months and
under 1 years, 1 to less than 3 years and 3 to 6 years old. UTI rate by age group is 2.8%,
3.2% and 2.4% respectively. However, according to Steven the UTI rate is higher
among babies aged one than over one year of age.
All the causal bacteria we managed to subdivide are negative gram ones, with
E.coli ranked first, followed by Proteus, Klebsiella, Enterobactrer and Citrobacter. Our
findings conform to those obtained in the research by Arreguin, Prais and Steven. UTI
causing bacteria in the community are also similar to their counterparts in the hospital.
The sensitivity of bacteria to antibiotics on the antibiogram: Most antibiotics
orally used to treat UTI, such as co-trimoxazole, ampixiline, amoxiciline and
chloramphenicol are strongly resisted. This findings conform to that of Arreguin, Prais.
However, third generation antibiotics of the group cephalosporine, nalidixic acid,
ciprofloxacine are still sensitive. This findings conform to that of Tran Dinh Long at al.
5. Conclusions
UTI incidence rate in children aged between two months and six years in the
community is 2.8%, and the rate is higher in girls than in boys (3.3% vs. 2.2%).
The causal bacteria are mostly gram negative, firstly E.coli, followed by Proteus,
and then Klebsiella. In addition, there are some other bacteria such as Enterobacter and
Citrobacter.
The bacteria resisted against common antibiotics taken orally to treat UTI.