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Published on: June 23, 2015
Study of urinary tract infection in children in one health district
Insights
Urinary tract infections (UTIs) in children are more common than often assumed. Even with low bacterial counts or sterile pyuria, further investigation is crucial for detecting abnormalities.
Area of Science:
- Pediatric Nephrology
- Clinical Microbiology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are a common pediatric concern.
- Accurate diagnosis and timely investigation are essential for preventing long-term renal damage.
- Current diagnostic approaches may underestimate the prevalence of UTIs in children.
Purpose of the Study:
- To quantify the incidence of UTIs and sterile pyuria in children.
- To assess the extent of further investigations following positive urine cultures or pyuria.
- To correlate laboratory findings with imaging results in pediatric urinary tract evaluations.
Main Methods:
- A one-year survey of urine specimens from children aged 12 years and under.
- Review of laboratory reports and urinary tract imaging findings.
- Analysis of urine bacterial counts and pyuria in relation to identified abnormalities.
Main Results:
- Over 12,500 urine specimens were analyzed from nearly 7,500 children.
- A significant proportion of children (13.9/1000 boys, 37/1000 girls) experienced infection or sterile pyuria.
- Nearly half of affected children underwent imaging, revealing new abnormalities in 1.5/1000 girls and 1.0/1000 boys, sometimes with low bacterial counts or no pyuria.
Conclusions:
- The prevalence of UTIs in the pediatric population is higher than commonly recognized.
- Absence of pyuria or low bacterial counts in urine cultures should not preclude further investigation.
- Sterile pyuria can also be indicative of underlying urinary tract abnormalities requiring attention.
Objectives:
To determine the number of children who had urine specimens sent for culture, who had infections or sterile pyuria, and who were investigated further. To relate the laboratory findings to the results of imaging.
Design:
One year survey of urine specimens submitted to a laboratory; review of previous and subsequent laboratory reports; review of the findings of imaging of the urinary tract.
Setting:
Portsmouth and South East Hampshire health district.
Subjects:
An estimated population of 89,086 children aged 12 years or under.
Main Outcome Measures:
Urine bacterial count and results of imaging.
Results:
12,551 urine specimens were submitted from 7450 children, 3138 boys and 4312 girls. 2238 children had infection or sterile pyuria at least once during the study (13.9/1000 boys, 37/1000 girls). 996 (45%) of the children with infection or sterile pyuria underwent some form of imaging. 128 children who had infection or sterile pyuria were already known to have urinary tract abnormalities and 114 children had newly identified abnormalities (1.0/1000 boys, 1.5/1000 girls). 50 (44%) of the children with newly detected abnormalities had no pyuria and 48 (42%) had bacterial counts below 10(8)/l. Eight children who had sterile pyuria on presentation were found to have abnormalities on imaging.
Conclusions:
Urinary tract infection is much commoner in children than is widely believed. Low bacterial counts, the absence of pyuria, or a finding of sterile pyuria should not be disregarded.
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