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Urinary Tract Infection In Children With Spina Bifida And Spinal Cord Injury
- 1. Urinary Tract Infection In Children With Spina Bifida And Spinal Cord Injury Obumneke Amadi, MPH(c) KKI/Ferguson Fellow JULY 2013
- 2. Spina Bifida What is Spina Bifida: Spina Bifida literally means “split spine.” Spina Bifida happens when a baby is in the womb and the spinal column does not close all of the way 3 Types of SB: • Occult Spinal Dysraphism • Spina Bifida Occulta • Myelomeningocele
- 3. Epidemiology Of Spina Bifida • 1 out of 1,000 infants in us born with Spina Bifida • 90-95% of babies born with Spina Bifida are born to parents with no family history of Spina Bifida • Most common in girls than boys • Most common neural tube defect SOURCE: What is Spina Bifida? - Spina Bifida Association Retrieved from www.spinabifidaassociation.org
- 6. Spinal Cord Injury What is Spinal Cord Injury A spinal cord injury begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. Types of SCI • Complete • Incomplete Source: Spinal Cord Injury (2013). National Institutes of Health. Retrieved from www.ninds.nih.gov/disorders/sci
- 7. Epidemiology Of Spinal Cord Injury • It is estimated that the annual incidence of spinal cord injury is approximately 40 cases per million population in the U. S. or approximately 12,000 new cases each year -the average age at injury was 28.7 years -most injuries occur between the ages of 16 and 30 -80.6% of spinal cord injuries occur among males -most common cause of SCI is falls, followed by acts of violence Source: Spinal Cord Injury Facts and Figures at a Glance(2012) - National Spinal. Retrieved from https://www.nscisc.uab.edu
- 8. Spinal Cord
- 9. Urinary Tract Infection(UTI) What is UTI: • UTI occurs when organisms in bladder cause infection ▫ >10,000 CFU in a catheterized sample ▫ >100,000 CFU in clean catch AND Fever Dysuria (painful urination) Frequency Back pain White blood cells in the urine • Bacteria are the most common cause of UTIs. Source: Urinary Tract Infections in Adults(2011). National Kidney andUrologic: Retrieved from kidney.niddk.nih.gov/kudiseases/pubs/utiadult
- 10. Epidemiology of UTI Incidence and Prevalence Incidence • Females: 1,200 cases per 100,000 persons annually • Males: 30 cases per 100,000 persons annually Prevalence • Females: 1,000 to 4,000 cases per 100,000 persons • Males: <100 cases per 100,000 persons source: Urinary Tract Infection(2012).Elsevier: https://www.clinicalkey.com/topics/urology/urinary-tract-infection.html
- 11. Organisms Associated With UTI • E coli (is the most common causing 75-90% of UTI) • Klebsiella species • Proteus species • Enterococcus species • Staphylococcus saprophyticus • Staph aureus • Fungal in immune compromised patients
- 12. Risk Factors 1. Bacterial virulence 2. Host factors : Anatomical: • Abnormal insertion of ureters in the bladder. • Urinary tract obstruction caused by phimosis, meatal stenosis • Indwelling catheter Functional: • *Neurogenic bladder in spina bifida patients and spinal cord injury Immunologic • Immune deficiency
- 13. Catheter
- 14. Urinary Tract
- 15. Antibiotic Sensitivity Antibiotic sensitivity is the susceptibility of bacteria to antibiotics. The AST test is usually carried out to determine which antibiotic will be most successful in treating a bacterial infection in vivo. Testing for antibiotic sensitivity is often done by the Kirby-Bauer method. The ranges include: • Susceptible: organisms exposed to antibiotic with a high likelihood of therapeutic success. • Intermediate : organisms exposed to antibiotic with an uncertain therapeutic effect. • Resistant: organisms are able to survive after exposure to one or more antibiotics
- 16. Antibiotic Sensitivity/Medication • Kirby-Bauer method Disc:
- 17. Medication These are the common Antibiotics used to treat UTI, they prevent complications of infections such as kidney damage. Most antibiotics come in pill or liquid form Source:Antibiotics for Urinary Tract Infections (UTIs)(2013). Retrived from Health-Encyclopedia - Kaiser Permanente.htm Generic Name Brand Name Ciprofloxacin Cipro Amoxicillin Amoxil, Augmentin,other Nitrofurantoin Furadantin, Macrobid, Macrodantin Sulfamethoxazole with Trimethoprim Bactrim, Septra
- 18. Purpose and Objectives • The purpose of the study was to examine organisms associated with UTI in the population of children with SB and SCI who were treated in out-patient and in- patient settings • Public health significance: Knowledge of the causative organisms associated with UTI in patients with SB and SCI is of public health significance to promote appropriate use of antibiotics and reduce kidney damage
- 19. Hypothesis • Children with spinal cord injury and spina bifida have a larger variety of organisms causing UTI than in the general population • Organisms causing UTI in Children with spinal cord injury and spina bifida will have more resistance
- 20. Method • A retrospective record review was conducted to extract data from medical records and a pre-existing data base of in- patients and out-patients with SB and SCI who were diagnosed with UTI. • Medical records from 2010-2013 were reviewed • Data on demographics (e.g., gender, age, and race/ethnicity), medical condition, medication, and organism responsible for UTI, organism antibiotic resistance, hospital status input & output will be obtained. • Chi square analysis was done to determine if there were statistically significant differences in the organisms infecting children with SCI versus SB.
- 21. Demographic (N=31) Characteristics n (%) Mean (SD) Gender (Male) 16 (52) Age (Years) 16.8 (7.8) Race White 17 (55) African American 10 (32) American Indian 3 (10) Other 1 (3) Ethnicity Hispanic 1 (3)
- 22. Organisms Infecting Patients with SB/SCI SB/SCI General Population E. Coli (35%) E. Coli (75-90%) E. Faecalis (25%) E. Faecalis (2.15%) Klebsiella sp.(13%) Staph sp (6.45%) Staph sp. (10%) Klebsiella sp (1.07%) There were no statistically significant differences in the organisms infecting children with SCI compared to SB (Pearson chi2 (5) =7.1803; P = 0.0208).
- 23. Antibiotic Susceptibility Pattern Rates for antibiotic sus/1 inter/ 2 resis /3 AMPICILLIN 14 0 13 AMP. SUBACTAM 13 0 6 PIPER)TAZO 19 0 2 CEFAZOLIN 17 1 3 CEFOXITIN 17 0 6 CEFRIAXONE 18 0 2 CEFEPIME 20 0 2 AZTREONAM 18 2 2 MER0PENEM 19 0 2 ERTAPENEM 18 0 2 TRIMETH_SULFA 16 0 3 TETRACYCLINE 12 3 13 GENTAMICIN 18 0 2 TOBRAMYCIN 17 1 3 AMIKACIN 19 1 1 CIPORFLOXACIN 17 0 5 NITROFURANTOIN 18 2 3 OXACILLIN 0 0 2 VANCOMYCIN 7 0 0 TOTAL 297 10 72 379 0 5 10 15 20 25 sus/1 inter/2 resis/3
- 24. Conclusion And Public Health Significance • E. coli is the leading cause of UTI in our study. • Contrary to the study’s of hypothesis, the susceptibility of the bacteria to commonly used antibiotics is good. • It is also recommended that proper sensitivity testing of Urinary tract infection causing organisms should be undertaken to guide the management of UTIs until the development of conclusive local guidelines to therapy. • Using antibiotic susceptibility data assists pediatric providers in using appropriate first line antibiotics when children present with symptoms of urinary tract infection.
- 25. Strengths And Weaknesses Strength • Study of specialized underserved population of children • Increased knowledge of the organisms causing UTI in patients with SB and SCI Weakness • Small sample size • Limited access to lab work in out patient population • Limited generalizability
- 26. Reference • Abdelaziz Elamin(n.d).Urinary tract infection in children. Retreived from www.pitt.edu/~super7/43011-44001/43861.ppt • Mohamad Fakih(n.d).Appropriate Urinary Catheter Use And Management Retrieved from http://www.catheterout.org • Urinary Tract Infection(2012).Elsevier: https://www.clinicalkey.com/topics/urology/urinary-tract-infection.html • Urinary Tract Infections in Adults(2011). National Kidney andUrologic: Retrieved from kidney.niddk.nih.gov/kudiseases/pubs/utiadult • What is Spina Bifida?(2012).Retrieved from www.spinabifidaassociation.org • Spinal Cord Injury Facts and Figures at a Glance(2012) - National Spinal. Retrieved from https://www.nscisc.uab.edu • Spinal Cord Injury (2013). National Institutes of Health. Retrieved from www.ninds.nih.gov/disorders/sci
- 27. Acknowlegement • CDC Ferguson Fellowship program • Kennedy krieger institue – mentors • Dr H.Belcher
Editor's Notes
- SB Dysraphism: Infants with this have a dimple in their lower back: SB Occulta: It is often called “hidden Spina Bifida” because about 15 percent of healthy people have it and do not know it. However, pain and neurological symptoms may occur Myelomeningocele : is the most severe form of Spina Bifida. It happens when parts of the spinal cord and nerves come through the open part of the spine. It causes nerve damage and other disabilities Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way. The backbone that protects the spinal cord does not form and close as it should. This often results in damage to the spinal cord and nerves. Spina bifida might cause physical and intellectual disabilities that range from mild to severe. The severity depends on: The size and location of the opening in the spine. Whether part of the spinal cord and nerves are affected. Types of Spina Bifida The three most common types of spina bifida are: Myelomeningocele (sounds like: my-low-ma-nin-jo-seal; hear how “myelomeningocele” sounds) When people talk about spina bifida, most often they are referring to myelomeningocele. Myelomeningocele is the most serious type of spina bifida. With this condition, a sac of fluid comes through an opening in the baby’s back. Part of the spinal cord and nerves are in this sac and are damaged. This type of spina bifida causes moderate to severe disabilities, such as problems affecting how the person goes to the bathroom, loss of feeling in the person’s legs or feet, and not being able to move the legs. Meningocele (sounds like: ma-nin-jo-seal; hear how “meningocele” sounds) Another type of spina bifida is meningocele. With meningocele a sac of fluid comes through an opening in the baby’s back. But, the spinal cord is not in this sac. There is usually little or no nerve damage. This type of spina bifida can cause minor disabilities. Spina Bifida Occulta (sounds like: o-cult-tuh; hear how “occulta” sounds) Spina bifida occulta is the mildest type of spina bifida. It is sometimes called “hidden” spina bifida. With it, there is a small gap in the spine, but no opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, spina bifida occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities
- Diagnosis Spina bifida can be diagnosed during pregnancy or after the baby is born. Spina bifida occulta might not be diagnosed until late childhood or adulthood, or might never be diagnosed. Source: Spina Bifida, Facts(2013). NCBDDD. Centers for Disease Control .Retrieved from www.cdc.gov/ncbddd/spinabifida/facts.html
- Vertebra which are the bones of the spine--any of the bones or segments composing the spinal column -Complete A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, in-addition to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day -Incomplete the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury
- not including those who die at the scene of the accident (primarily gunshot wounds).
- Cervical spinal nerves (C1 to C8) control signals to the back of the head, the neck and shoulders, the arms and hands, and the diaphragm. Thoracic spinal nerves (T1 to T12) control signals to the chest muscles, some muscles of the back, and parts of the abdomen. Lumbar spinal nerves (L1 to L5) control signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg. Sacral spinal nerves (S1 to S5) control signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus.
- Colony forming units/ml Urine should be sterile however there are specific criteria for UTI organisms in bladder urine including fungi, viruses, and bacteria. 3 - This occurs as a result of bacterial invasion of the bladder due to the ascending infection from perianal contaminates, usually the bowel flora such as Escherichia coli.
- Incidence : measure of new case Prevalence : the degree to which something is affected Demographics Age Among infants up to 6 months of age, UTI is more common in boys than girls Among persons between 1 and 65 years of age, UTI predominantly occurs in female patients Among persons over age 65, bacteriuria affects men and women roughly equally Gender UTI is more frequent in females than in males Uncircumcised male infants have a higher incidence of UTI
- Bladder is more common in conditions associated with infrequent or incomplete voiding. Phimosis :tightening of the foreskin of the penis that may close the opening of the penis meatal stenosis:is a narrowing of the opening of the urethra, the tube through which urine leaves the body
- Organisms attach to and grow on a surface and cause infection
- This is the possible site of bacterial contamination. The American Heritage® Science Dictionary Copyright © 2010 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company.
- Source: File:Antibiotic sensitvity and resistance.Retrieved from JPGWikipedia, the free encyclopedia
- National Hospital Ambulatory Medical care survey, stated that UTI caused nearly 7 million physicians visits and 1 million EMS visits, leading to 100,000 hospitalizations.
- Gender - male,female Race - white, Asian, Black, American Indian Ethnicity - Non-Hispanic, Hispanic Diagnosis- Spinal cord injury, Spina Bifda Antibiotic- Susceptibility, Intermediate, Resistance Patient Status- in-patient, out-patient Medication
- This a line graph I constructed form our anti bio sus pattern data that shows the rate of antibiotic sus in higer compared to resist, which indicates that organisms are responding well to medication.
- However it is not as common a pathogen as it is in the general population. The organisms that infect or cause urinary infection in patients with sb and sci are more diverse than in the general population
- Sub acute peaaditric reharb hospital
- To exit my presentation.