Bacteremic urinary tract infection in children.

OBJECTIVE: To assess the clinical characteristics of bacteremic urinary tract infection (UTI) in children. DESIGN: Clinical data of Finnish children with bacteremic UTI (n = 134) from 1985 to 1994 were analyzed. Their symptoms, laboratory and imaging findings were compared with those of age- and sex-matched patients hospitalized for blood culture negative UTI. RESULTS: Generally, no major differences were seen in clinical findings between bacteremic and nonbacteremic patients. Bacteremic children had more frequent feeding problems (P = 0.02), and children > or =12 months of age tended more often to have abdominal pain and vomiting than did nonbacteremic patients. Fever was the major initial symptom in both study groups, but no significant difference occurred in the mean highest temperature or in the mean of duration of fever before admission to the hospital. The mean concentration of serum C-reactive protein on admission was significantly higher in bacteremic patients (116 vs. 76 mg/l; P < 0.01). After onset of antimicrobial treatment fever lasted significantly longer in bacteremic patients than in control patients (means, 2.3 vs. 1.1 days; P < 0.01). Anatomic or functional abnormalities in the urinary tract were detected in 51% vs. 46%, respectively. Obstruction of the urinary tract (9% vs. 1%, P < 0.01) and Grade 3 to 5 vesicoureteral reflux (30% vs. 16%, P = 0.02) were significantly more frequent in bacteremic patients with UTI. Obstruction or vesicoureteral reflux was found in 46% of children with bacteremic UTI caused by Escherichia coli vs. 89% of children with non-E. coli infection (P < 0.01). CONCLUSIONS: Clinical symptoms do not significantly distinguish bacteremic from nonbacteremic children with UTI. Outcome of bacteremic UTI was comparable with that of nonbacteremic UTI. Bacteremic children, especially those with non-E. coli UTI, more often had anatomical or functional abnormalities in the urinary tract.

Ultrasonography as a screening procedure in children with urinary tract infection.

Renal ultrasonography, excretory urography and radionuclide-voiding cystography or conventional voiding cystourethrography were performed in 76 children with urinary tract infection. Forty children had functional or anatomical abnormalities. Twenty-eight children had vesicoureteral reflux and 12 children had an obstructive lesion. All 12 children with obstructive lesions as well as 4 children with reflux and hydronephrosis required corrective surgery. Ultrasonography as the initial procedure detected 14 of these cases and the other 2 were discovered in voiding cystourethrography. Our data and those in the literature suggest that renal ultrasonography may be the method of choice in children with urinary tract infection. This is followed by voiding cystourethrography or radionuclide-voiding cystography. Excretory urography is not necessary in the initial evaluation of these patients, but it should be utilized when the other imaging methods show an abnormality and more detailed anatomical visualization of the upper urinary tract is required. Using this protocol in children with urinary tract infection, unnecessary radiation, discomfort and expense will be avoided.