Clinico-microbiological determinants of urinary tract abnormality following first culture proven urinary tract infection in children

Introduction: Clinico-microbiological factors would help clinicians in developing countries to optimize the use of radioimaging childhood urinary tract infection (UTI), especially in resource limited settings with financial constraints

Objective: To study the clinico-microbiological profile and determine the association of renal tract abnormalities in children with their first documented UTI and to find out the clinico-microbiological determinants of the anomalies.

Method: This prospective study was carried out over a period of two years in a tertiary care teaching hospital at Ahmedabad, Gujarat after obtaining permission from institutional review board. A total of 65 children up to 12 years of age with first culture proven UTI, were recruited from the paediatric outpatient department (OPD), paediatric ward and neonatal intensive care unit (NICU) after obtaining parental consent.

Results: Most (49.2%) patients belonged to the 1-5 year age group. There were 36 (55.4%) males. Fever (69.2%) was the commonest symptom followed by excessive crying (29.2%) and dysuria (27.7%). Of the 65 patients, 15.3% had complicated UTI, 29.2% required hospitalization and 4.6% had hypertension. Of male patients 91.7% were uncircumcised. Malnutrition was found in 57.9% of patients in the under 5 year age group. We found altered renal function tests (RFTs) in 6.1%, leucocytosis in 29.2% and pyuria in 35.2% patients. Escherichia coli caused 40% of the infections, followed by Klebsiella (29.2%). Renal abnormalities were found in 27 (41.5%) with statistically significant (p<0.05) correlation with young age, complicated UTI, haematuria, oliguria, hypertension, altered RFTs, malnutrition and non-Escherichia coliorganisms. Ultrasonography (USG) detected abnormalities in 24/65 (36.9%), micturating cystourethrogram (MCUG) in 7/32 (21.8%) and DMSA revealed scar in 4/32 (12.5%) patients. USG had sensitivity of 88.8%.

Conclusions: Escherichia coli caused 40% of the UTI, followed by Klebsiella (29%). Renal anomalies were found in 41.5% with statistically significant correlation with young age, complicated UTI, haematuria, oliguria, hypertension, altered RFTs, malnutrition and non-Escherichia coli.

Sri Lanka Journal of Child Health, 2018; 47(2): 104-111