Outcome of Children with First Episode of Urinary Tract Infection
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 1
Abstract
Background: Urinary tract infection (UTI) is one of the most common childhood infections. UTI occurs in 1–3% of girls and 1% of boys of the pediatric population. In the former, it occurs by the age of 5 years which peaks during infancy and toilet training and in the later during the 1st year of life. UTIs are much more common in uncircumcised boys, especially in the 1st year of life. The prevalence of UTI during the 1st year of life is more in males with a male:female ratio of 2.8–5.4:1. Beyond 1–2 years, female preponderance with a male:female ratio of 1:10 is observed. Aim of the Study: The aim is to study the outcome of first episode of UTI in children in terms of treatment response, recurrence, need for surgical intervention, renal scarring, growth retardation, hypertension, and renal function abnormalities. Materials and Methods: A total of 120 children between 1 month and 12 years of age with the first episode of confirmed diagnosis of UTI were included in this prospective cross-sectional study. All the children were thoroughly investigated after elicitation of history. Culture of urine, ultrasonogram, micturating cystourethrogram (MCU), and technetium 99m-labeled dimercaptosuccinic acid investigations were done in addition to routine investigations before and during follow-up of treatment. Children were treated standard UTI treatment protocols recommended by the International Pediatric Society. All the data were analyzed using standard statistical methods. Observations and Results: A total of 120 children with the first episode culture positive UTI between the age group 1 month and 12 years were taken; 63.4% were male children and 36.6% were female children. Of 120 cases studied, 28 (23.3%) cases were below 1 year, 60 (50%) cases were between 1 and 5 years, and 32 (26.6%) cases were between 5 and 12 years. 88 (73.3%) Escherichia coli, 21 (17.5%) Klebsiella, 3 each of CONS, Enterobacter, and Staphylococcal aureus, and 2 Acinetobacter species were isolated. Most common organism isolated was E. coli followed by Klebsiella. MCU was done in 40 cases (31 males and 9 females) and was abnormal in 12 (30%) cases. 4 (10%) and 2 (5%) of 40 cases had grade 1–2 vesicoureteral reflux (VUR) and grade 3–4 VUR, respectively. 6 (7.9%) of 76 males studied had posterior urethral valve. All children with posterior urethral valves (PUV) had undergone cystoscopic fulguration, and 4 of these 6 children had undergone pyeloplasty after fulguration. Conclusions: The recurrence chance of UTI is present in 7.5% of children within 6 months of first episode of UTI. Majority of children with recurrent UTI had their second episode within 6 months and that too, with the same organism suggesting an unresolved or persistent bacteriuria. The presence of VUR is a risk for recurrence of UTI and renal scarring. The relative risk of recurrence of UTI is 14 times in the presence of renal scarring than in children without renal scar formation, and thus, renal scarring is a good predictor of recurrence.
Authors and Affiliations
M S Vinodkumar, M Vishnu Mohan
Keywords
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