A prospective study of urinary tract infections in children

Objective To study the pattern of urinary tract
infection (UTI) in children paying special attention to
initial confirmation of diagnosis by urine culture.

Design A prospective study over a period of twelve
months.

Setting Private sector hospitals in Colombo.

Subjects Children presenting with a suspected
diagnosis of UTI.

Investigations UTI was confirmed by a positive urine
culture with a colony count of >105 organisms/ml in a
clean catch sample. Subsequent investigations
included renal ultrasound scans, MCUGs and renal
function tests; IVUs, DMSA & DTPA scans were
done in a few patients.

Results 165 patients (97 boys and 68 girls) were
studied. 54% of patients were under 1 year of age.
Common presenting symptoms were fever (41%),
dysuria (32%), frequency of micturition (15%) and
failure to thrive (8%). The commonest organisms
isolated were E.coli (41%), coliforms (38%) and
Klebsiella (13%). The 2 most common antibiotics
used initially were nalidixic acid and cotrimoxazole.
On investigating further, out of 143 patients who had
ultrasonography, abnormalities were seen in 17
(12%) and in 72 patients who had MCUGs
performed, 17 (24%) showed evidence of
vesicoureteric reflux (VUR). 17 patients were
referred for surgical intervention.

Conclusion A diagnosis of UTI in children should be
established with the "gold standard" of a significantly
positive urine culture before embarking on treatment
and further investigations. Special emphasis should
be paid to the collection and transport of urine. Once
the diagnosis is established, regular follow-up is
essential 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