A prospective study of urinary tract infections in children

Abstract

Objective To study the pattern of urinary tractinfection (UTI) in children paying special attention toinitial confirmation of diagnosis by urine culture.Design A prospective study over a period of twelvemonths.Setting Private sector hospitals in Colombo.Subjects Children presenting with a suspecteddiagnosis of UTI.Investigations UTI was confirmed by a positive urineculture with a colony count of >105 organisms/ml in aclean catch sample. Subsequent investigationsincluded renal ultrasound scans, MCUGs and renalfunction tests; IVUs, DMSA & DTPA scans weredone in a few patients.Results 165 patients (97 boys and 68 girls) werestudied. 54% of patients were under 1 year of age.Common presenting symptoms were fever (41%),dysuria (32%), frequency of micturition (15%) andfailure to thrive (8%). The commonest organismsisolated were E.coli (41%), coliforms (38%) andKlebsiella (13%). The 2 most common antibioticsused initially were nalidixic acid and cotrimoxazole.On investigating further, out of 143 patients who hadultrasonography, abnormalities were seen in 17(12%) and in 72 patients who had MCUGsperformed, 17 (24%) showed evidence ofvesicoureteric reflux (VUR). 17 patients werereferred for surgical intervention.Conclusion A diagnosis of UTI in children should beestablished with the "gold standard" of a significantlypositive urine culture before embarking on treatmentand further investigations. Special emphasis shouldbe paid to the collection and transport of urine. Oncethe diagnosis is established, regular follow-up isessential to prevent renal damage.Sri Lanka Journal of Child Health, 2001; 30: 31-6(Key words: urinary tract infections, vesico-ureteric reflux, children, renal damage)DOI : 10.4038/sljch.v30i2.825