Urinary tract infection in children: clinical aspects and utility of urine dipstick test

Abstract

Background: Urinary tract infection (UTI) is a common genitourinary disease in children and accounts for significant morbidity. To prevent the potentially dangerous sequel, early detection of UTI in childhood is essential. This depends entirely on strong clinical suspicion and urine culture report. Recently, advances in investigations are taking place to diagnose UTI rapidly. Urine dipstick is one such bedside method to diagnose UTI. This study aims at studying the clinical features of UTI and evaluating sensitivity and specificity of urine dipstick in diagnosing UTI.Methods: This study was conducted at a tertiary care hospital in Vadodara from January 2013 to June 2014, on 60 children admitted with clinical suspicion of urinary tract infection. Along with study of clinical features, results of urine dipstick tests (Nitrite and Leukocyte esterase), urine microscopy and urine culture were compared. Accuracy of urine dipstick tests was assessed statistically by evaluating sensitivity, specificity, positive and negative predictive values considering urine culture as a gold standard.Results: Fever was found to be the most common presenting features (53%) in all the patients studied. The sensitivity of urine microscopy, Nitrite test and Leucocyte esterase test was 63.5%, 50% and 61% and specificity was 25%, 31% and 25% respectively. Combination of Nitrite and Leucocyte Esterase test had an improved sensitivity (68%).Conclusions: Urinary tract infection can present with variety of non-specific signs and symptoms especially in younger age. Dipstick test using Leucocyte Esterase and Nitrite together is better than urine microscopic examination alone. Urine culture as a confirmatory test still remains gold standard.

Clinico-microbiological determinants of urinary tract abnormality following first culture proven urinary tract infection in children

“…In keeping with other studies, Gram negative organisms accounted for over 90% of the isolates with E. coli (40%) predominating 7,12,13,16,19,21 . Many studies 10,14,15,17,22 found E-coli in the range of 63-88%.…”

“…Out of 205 clinically suspected UTI cases, 65 (31.7%) had positive urine culture, which was close to other studies ranging from 35% to 45% 7,8,9 . Out of 65 patients, 21.6% were below 1 year of age, matching with observations of other researchers 10,11,12 . Though the commonest age for the first symptomatic UTI is the first year of life in both genders, the reason the for the low number could be the small sample size and nonspecific complaints leading to under-diagnosis at this age 3,4 .…”

“…Though the commonest age for the first symptomatic UTI is the first year of life in both genders, the reason the for the low number could be the small sample size and nonspecific complaints leading to under-diagnosis at this age 3,4 . Maximum cases (49.2%) were in age group of 1-5 years as in other studies 8,9,10,12 . Males outnumbered females by a smaller proportion except in the 5-12 year age group with a male: female ratio of 1:1.3.…”

“…Straining and poor urinary stream were found mostly in male patients. Increased frequency of micturition 12,16,19 and haematuria 12,19 have been also reported. Poor weight gain 9,10,15,19 , febrile seizure 15,19 , vomiting [8][9][10]15,16 , diarrhoea 10,13,15 and abdominal pain 8,9,13,15,16 were documented by other studies.…”

“…After fever (69.2%) and excessive crying/ irritability (29.1%), urinary symptoms like dysuria (27.7%) and increased frequency of micturition (27.7%) predominated. Other studies also indicated high association between fever and UTI [8][9][10][11][12][13][15][16][17] . According to the World Health Organisation (WHO), fever as a marker of UTI has a sensitivity of 80% and specificity of 40% 18 .…”