Background: Urinary tract infection is a common pediatric bacterial infection associated with significant morbidity and increasing antimicrobial resistance, particularly in low- and middle-income countries. Updated local data regarding microbiological patterns and antibiotic susceptibility in children with UTI remain limited in Bangladesh. Methods: This cross-sectional study was conducted in the Department of Pediatric Nephrology, Bangladesh Medical University, from August 2023 to January 2026. Among 242 children aged <18 years with symptoms suggestive of UTI, 188 fulfilled criteria for presumptive UTI based on pyuria and/or positive dipstick findings. Urine culture and antibiotic susceptibility testing were performed for all presumptive cases. Children with asymptomatic bacteriuria, recent antibiotic exposure, prophylactic antibiotics, or contaminated cultures were excluded. Confirmed UTI was defined by significant growth of a single organism in urine culture. Demographic, clinical, microbiological, and antimicrobial susceptibility data were analyzed using SPSS version 26.0. Results: Culture-positive UTI was identified in 78 children (41.5%). Females predominated (55.9%), and most patients were below five years of age. Fever (67.0%) and dysuria (39.4%) were the most common presenting symptoms. Associated renal disease was present in 60.1% of cases, most commonly nephrotic syndrome and hydronephrosis. Klebsiella species (38.5%) were the predominant uropathogens, followed by Escherichia coli (21.8%). Gram-negative isolates demonstrated high susceptibility to carbapenems, aminoglycosides, nitrofurantoin, and colistin, while resistance to commonly used antibiotics was substantial. Female sex, uncircumcised male infants, high-grade fever, and associated kidney disease were independent predictors of culture-positive UTI. Conclusion: Pediatric UTIs in this tertiary nephrology setting were frequently associated with underlying renal abnormalities and multidrug-resistant non–E. coli organisms. Early urine culture, culture-guided therapy, and strengthened antimicrobial stewardship are essential to improve outcomes and limit antimicrobial resistance.
Aims: This study explored rural disparities in eyecare utilization among adult patients with diabetes with mild/moderate and severe diabetic retinopathy in the rural state of West Virginia, United States. Methods: Demographic characteristics, clinical and vision/eye care utilization data were collected from electronic health records at West Virginia University Eye Institute and affiliated teleophthalmology clinics. A manual review identified patients who received eye care services between October 2015 and March 2024 (n=11,633). Patient’s residence was categorized using the rural-urban commuting area codes. Unadjusted and adjusted logistic regression of eye-care visits by diagnosis (diabetes, mild/moderate diabetic retinopathy, severe diabetic retinopathy and rural residence were conducted adjusting for sociodemographic, behavioral, clinical factors and comorbidities. Results: The mean age and HbA1c was 59.7 ± 14.2 years and 7.8 ± 1.9%, respectively. In the adjusted multivariable logistic regression controlling for established risk factors, rural residence was associated with higher visits (OR = 1.47, 95% confidence interval [CI] = 1.04 to 2.08), P<.001. Higher visits were also noted among rural (vs. urban) patients with severe DR complications (aOR=1.70; 95% CI = 1.48 to 1.96) and mild/moderate DR (aOR= 1.34; 95% CI = 1.18 to 1.52), P<.001. Conclusions: A clear rural disadvantage was noted in eyecare utilization among rural patients with severe diabetic retinopathy. Teleophthalmology may provide opportunities for timely screening and treatment to reduce preventable blindness.
