The relationship between infecting organisms and underlying structural anomalies in children with urinary tract infections

Abstract

Introduction: Urinary tract infections (UTIs) are a common cause of morbidity in childhood with potential for renal scarring and reflux nephropathy which can lead to hypertension and end-stage renal failure. Aim: The aim of this study was to investigate the relationship between the infecting organism and any underlying anomalies of the urinary tract which may predispose to the development of infections and which may alter the management of children with UTIs. Methods and results: A total of 72 cases of UTI were recorded retrospectively (in- and outpatients), with ages ranging from 3 days to 48 months (mean 9.5, median 5 months). Fifty seven (79%) of patients had their first reported urinary tract infection under the age of 1 year.. Fifty eight (80.6%) were E. coli infections. These presented at an older age than non-E. coli infections. Investigations were abnormal in 31 (43%) cases. The mean age for first infection in patients with abnormal investigations was 7.7 months (median 2 months), younger than those with no renal tract abnormalities. Organisms other than E. coli were rarely found when no significant abnormalities were detected with investigation by US and MCUG and this was a statistically significant difference (p<0.001). Renal scarring was identified in 10 (13.9%) patients. Discussion: This study confirms that non-E. coli UTI is associated with underlying renal pathology and that early infections with any organism are more likely to be associated with underlying abnormalities. We also outline an algorithm based on the recent NICE 2007 guidelines which will be adopted by the Paediatric Department, Mater Dei Hospital for the investigation of UTI.