Urinary tract infection in children younger than 5 years . Etiology and associated urological anomalies

Objectives: To investigate the most common underlying organisms, and associated urological anomalies in children presenting with urinary tract infection (UTI). Methods: Retrospectively, all children with confirmed UTI between October 2013 and February 2014 were evaluated at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The electronic files of 279 children presenting with UTI, aged less than 5 years were reviewed. Results: A total of 153 patients (85 males) with a mean (SD) age of 15 (19.86) months were included in the study. Recurrent UTI was present in 45.1%. Urine collection in children less than 2 years of age was through trans-urethral catheterization in 69.4%, while midstream urine was the main method in those above 2 years (78.6%). Escherichia coli (E. coli) was the causative organism in 41.2% of first UTI. The second most common organism was Klebsiella Pneumoniae, seen in 19.6%. Urological anomalies were found in 28.1% of the overall study population. Ninety percent of those with single UTI did not have anomalies. However, urological anomalies were reported in 50.7% of those with recurrent episodes of UTI (p<0.005). Non-E. coli cases were associated with a higher percentage of abnormal renal ultrasonography results (p=0.006). Conclusion: Escherichia coli was the most common causative organism for UTI, and a single episode of UTI signified normal urological anatomy. Saudi Med J 2015; Vol. 36 (4): 497-501 doi: 10.15537/smj.2015. 4.10770 U tract infection (UTI) is common in children. Early diagnosis and management is essential to minimize the acute morbidity and prevent the long-term complications associated with UTI, which include hypertension and renal scarring. However, considerable controversy prevails in the diagnosis and management of UTI in children.1 Major changes have also been presented in recent treatment guidelines.2,3 Blood investigations such as leukocyte count with urine analysis and inflammatory markers such as C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), might indicate the presence of an infection, but confirmation is only by urine culture. Midstream urine is the standard method in older children, but in young children selecting the best-suited method of urine collection is crucial to avoid false positive results. Using urine bags for collecting specimens for culture is discouraged as it increases the possibility of false positive results.4 Urinary tract infection is associated with renal anomalies in children,1 and investigation of affected children is recommended to diagnose renal anomalies. An ultrasound study is recommended by both the American Academy of Pediatrics,2 as well as the National institute of Clinical Excellence (NICE)3 as initial screening. Voiding cystourethrogram (VCUG) is used to detect vesicoureteral reflux, and DMSA (dimercaptosuccinic acid) scan to detect renal scars.1-3 The DMSA scan is recommended before VCUG by NICE in children aged 6 months to 3 years.3 The DMSA scan could replace VCUG as the first line procedure, and this approach is recommended by many investigators.5 In Saudi Arabia, due to a high rate of consanguinity,6 the risk of renal anomalies looms large; it is believed that up to 70% of renal anomalies in children can be attributed to an underlying genetics cause.7 In this study, we aimed to detect abnormal renal US findings in children aged <5 years with a UTI, and compare the etiology of infection and abnormal US finding in cases with first episode of infection with those with recurrence of infection. Methods. A retrospective review was conducted, inclusive of all children who had UTI confirmed by urine culture and who presented to King Abdulaziz University Hospital, Jeddah, Saudi Arabia between October 2013 and February 2014. We reviewed electronic files of 279 children aged less than 5 years of age. Urinary tract infection was defined as bacterial growth of 105 CFU/ML. Patients with a colony count Brief Communication Disclosure. This study or any part of it was not presented in a conference proceeding. Authors have no conflict of interests and the work was not supported or funded by