Hong Kong Journal of Paediatrics

Volume 9 Number 1, January 2004
Abstract

Symptomatic Urinary Tract Infection in Children: Experience in a Regional Hospital in Hong Kong

KW FONG, SN WONG

We performed a retrospective review of the demographic, clinical, imaging and outcome data of 94 children diagnosed in our hospital to have symptomatic urinary tract infection (UTI) between January 1994 to June 1996. Our findings were compared with previous local reports to look for changing epidemiology, and with overseas studies to look for ethnic differences. We found that in this local Chinese cohort, UTI mainly affected boys (78%) and infants (85% <1 year), in whom it presented with fever and non-specific symptoms. The diagnosis was established by demonstrating pyuria and significant positive bacterial culture from either suprapubic aspirated (42.5%), catheter (34%) or clean catch urine (14.9%) samples, but 8 patients required DMSA scan for retrospective diagnosis because of mixed growth in bag urine or no growth due to prior antibiotic therapy. The causative organisms were E. coli in 78% of cases, but could also be Klebsiella, Proteus and Enterococci. Complete imaging studies were performed in 86% of our patients and revealed hydronephrosis in 12%, VUR in 23%, persistent renal scarring in 16% of patients. No abnormalities were found in 56%. There was a strong association between VUR, recurrent UTI and renal scarring. On medium term follow up, 16% of patients had recurrence of UTI. The prognosis was favourable as 77% of the 31 refluxing units and 43% of hydronephrosis detected resolved spontaneously. One patient required partial nephrectomy and excision of ureterocele and two patients required circumcision. An overall of 21 patients (22%) had "complicated" UTI and they required long term follow up management, preferably by paediatric nephrologists in consultation with urologists. (HK J Paediatr (new series) 2004;9:30-36)

Key words : Children; Chinese; Renal scarring; Urinary tract infection; Vesicoureteral reflux



Back to Previous Page