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Symptomatic urinary tract infection in preschool Australian children
J C Craig1, L M Irwig, J F Knight
1Centre for Kidney Research, Royal Alexandra Hospital for Children, Sydney, Australia.
Insights
This study on young children with urinary tract infections (UTIs) found E. coli was the main cause, with high antibiotic resistance. Renal tract abnormalities were common, highlighting the need for prompt diagnosis and management in pediatric UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Microbiology
Background:
- Urinary tract infections (UTIs) are common in young children, but data on their features and outcomes in Australia are limited.
- Early diagnosis and management are crucial to prevent long-term renal complications.
Purpose of the Study:
- To characterize the demographic and clinical presentation of symptomatic UTIs in Australian children under five years old.
- To investigate short-term outcomes, causative microorganisms, and the prevalence of renal tract abnormalities.
Main Methods:
- A consecutive cohort of 304 children under five with their first documented symptomatic UTI were analyzed.
- Renal tract sonography, micturating cystourethrography, and dimercaptosuccinic acid (DMSA) scintigraphy were routinely performed.
- Clinical data and microbiological findings were recorded.
Main Results:
- Escherichia coli (E. coli) caused 84% of UTIs, with 54% resistance to ampicillin/amoxicillin.
- Bacteraemia occurred in 6% of infants under six months.
- Abnormal DMSA scans were found in 39%, and vesicoureteric reflux in 28% of children.
- Dipstick urinalysis and pyuria on microscopy showed 85% sensitivity for UTI detection.
Conclusions:
- This study provides current, localized data on pediatric UTIs, informing clinical management.
- The findings underscore the importance of considering renal tract abnormalities in young children with UTIs.
- High antibiotic resistance necessitates careful empirical treatment choices.
Objective:
To describe the demographic and clinical features, short-term outcomes, microbiology and renal tract abnormalities of a cohort of young Australian children with symptomatic urinary tract infection.
Methodology:
A total of 304 children < 5 years with their first documented symptomatic urinary tract infection who presented consecutively to the Emergency Department of a paediatric hospital between March 1993 and December 1994 and without a known predisposing cause were identified and details of their acute illness were recorded. Renal tract sonography, micturating cystourethrography and Tc-99 m dimercaptosuccinic acid scintigraphy (DMSA) were routinely performed.
Results:
Of those who presented with urinary tract infection, 169 were boys and 135 girls; 64% were less than 1 year of age. For children from the local community, the cumulative incidence of urinary tract infection within the first 5 years of life was estimated to be 1.9% for boys and 1.8% for girls. There were no significant differences in illness characteristics according to mode of referral or geographical locality. Presenting symptoms were generally nonspecific and not referrable to the urinary tract. There were no deaths. One per cent of children required ventilatory support, and bacteraemia occurred in 6%, all of whom were under 6 months of age. E. coli was the causal organism in 84%, and a high in vitro resistance to ampicillin/ amoxycillin (54%) was demonstrated by the pathogens isolated. Bacteriuria was eradicated in 99% with antimicrobial treatment. In this setting, the sensitivities of dipstick urinalysis (leucocyte esterase+/-nitrites) and pyuria on microscopy (>10 x 10(6) white cells L(-1)) were 85%. Abnormal DMSA scintigraphy was detected in 39%, vesicoureteric reflux in 28%, and obstructive uropathy in 1%.
Conclusions:
This study provides current and local data on a large sample of children <5 years with urinary tract infection, which are useful to clinicians who manage children at risk of the condition.