Caracterización microbiológica de los gérmenes causantes de infección urinaria y factores del huésped en la población pediátrica en el hospital militar central del año 2006 a 2012

Introduction: the urinary tract infection is one of the most common bacterial infections in children (representing 7% of bacterial infections), and it´s early diagnosis and treatment could impact in complications. That is the reason why the empirical antibiotic used for treatment, is directed to the most frequent microorganisms. The sensibility Escherichia coli reported in 2002 in The Central Military Hospital was satisfactory (86%) to continue the same first line of treatment (Cephalotin) in children with febrile urinary tract infections. In many national and international studies has been reported an increase in the resistance to first level cephalosporins, with secondary changes in first line treatment. However the changes in the sensibility in the last years in our hospital is unknown, also if there are hostage factors that affect this changes in the sensibility. Objectives: determine the changes in bacterial sensibility in urinary infections and it´s relation with hostage factors in the pediatric patients of The Central Military Hospital between the years 2006-2012. Materials and methods: it´s a cross-section study, including children between 0 and 14 years since January 2006 and December 2012, with confirmed diagnosis of urinary tract infection with positive urine culture depending on the recollection method. Were excluded those without urine culture or incomplete information, immune-compromised, with oncologic or neurologic diseases. The data recollection included microorganism, sensibility and resistance to common antibiotics and hostage factors (age, gender, presence of fever, previous antibiotic treatment, obstructive diseases and urinary reflux). Results: there were 271 infections, 79,9% by Escherichia coli whose resistance to first level cephalosporins was low (18%) and moderate to TMP-SMX and ampicillin. For E. Coli infections, the risk factors with more probability of presenting urinary tract infections resistant to first level cephalosporins are: fever (OR: 3.2), below 1 year of age (OR: 2.6), previous antibiotic treatment (OR: 1.19), urinary reflux (OR 1.52); and the risk factors related to multi-restistant urinary tract infections are: fever (OR: 9.99), recurrent urinary tract infection (OR: 1.36), below 1 year of age (OR: 2), previous antibiotic treatment (OR: 2.2), obstructive uropathy (OR: 2.18) and urinary reflux(OR: 2). Conclusions: the global sensibility to first level cephalosporins is 82%, which is high. And following the risk factors analized we recomend: for febrile urinary tract infection we recommend first level cephalosporins. For unfebrile infections we recommend nitrofurantoin or nalidixic acid. If risk factors are present, program clinical control with urine culture to change or continue the treatment, because they have more risk for resistance. Key words: urinary tract infection, resistant microorganisms