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.