Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Butler, Christopher Collett; O’Brien, Kathryn; Pickles, Timothy; Hood, Kerenza; Wootton, Mandy; Howe, Robin; Waldron, Cherry-Ann; Thomas-Jones, Emma; Hollingworth, William; Little, Paul; Voort, Judith van der; Dudley, Jan; Rumsby, Kate; Downing, Harriet; Harman, Kim

doi:10.3399/bjgp15x684361

Cited by 21 publications

(18 citation statements)

References 9 publications

(10 reference statements)

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“…As in previous trials, we also found hematuria and proteinuria to be good indicators of UT pathology (66% and 56% respectively) [10,15]. The prevalence of UTI in our study was higher than earlier findings for same age group [32], but this is not surprising given the fact that almost half of the children had chronic infections with S . haematobium .…”

Section: Discussionsupporting

confidence: 82%

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial

et al. 2017

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BackgroundSchistosoma haematobium infections are responsible for significant urinary tract (UT) complications. Schistosomiasis control programs aim to reduce morbidity, yet the extent of morbidity in preschool-aged children and the impact of treatment on morbidity reduction are not well studied.MethodologyOur study was embedded in a randomized, placebo-controlled, single-blind trial in Côte d’Ivoire, which evaluated the efficacy and safety of three doses (20, 40 and 60 mg/kg) of praziquantel in school-aged (SAC) and preschool-aged (PSAC) children infected with S. haematobium. Enrolled children were invited to participate in an ultrasound examination prior and six months after treatment. At these time points 3 urine samples were collected for parasitological and clinical examinations.Principal findings162 PSAC and 141 SAC participated in the ultrasound examination at baseline, of which 128 PSAC and 122 SAC were present at follow-up. At baseline 43% (70/162) of PSAC had UT morbidity, mostly at bladder level and 7% had hydronephrosis. 67% (94/141) of SAC revealed mainly moderate UT pathology, 4% presented pseudopolyps on the bladder wall, and 6% had pyelectasis. At follow up, 45% of PSAC and 58% of SAC were S. haematobium positive, mostly harboring light infection intensities (41% and 51%, respectively). Microhematuria was present in 33% of PSAC and 42% of SAC and leukocyturia in 53% and 40% of PSAC and SAC, respectively. 50% (64/128) of PSAC and 58% (71/122) of SAC presented urinary tract morbidity, which was mainly mild. A significant correlation (p<0.05) was observed between praziquantel treatment and reversal of S. haematobium induced morbidity. Progression of UT pathology decreased with increasing praziquantel dosages. A worsening of morbidity was observed among children in the placebo group.Conclusion/SignificanceBladder morbidity is widespread among PSAC. Praziquantel treatment is significantly associated with the reversal of S. haematobium induced morbidity, which underscores the importance of preventive chemotherapy programs. These programs should be expanded to PSAC to prevent or decrease the prevalence of morbidity in young children. This trial is registered as an International Standard Randomized Controlled Trial, number ISRCTN15280205.

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Section: Discussionsupporting

confidence: 82%

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial

et al. 2017

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“…Urinary tract infection (UTI) is a worldwide health problem in the pediatric population, with a prevalence of 5.6 -7.0% in young children presenting acutely ill to primary care [1][2][3]. It has 1 1 been estimated that 3-7% of girls and 1-2% of boys will be diagnosed with UTI by six years of age, and the disease will recur in 12-30% of these children.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Primary and Recurrent Urinary Tract Infections in Children

Doğan

İpek

2020

Cureus

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We aimed to compare the demographic and ultrasound data regarding first-episode urinary tract infections with recurrent infections in children. Methods A total of 509 children aged 0-16 years who were diagnosed to have a urinary tract infection (UTI) as confirmed with positive urinary culture tests were retrospectively investigated. A comparison of baseline parameters, responsible pathogen incidences, and ultrasound findings was made between children who had a single episode of UTI (n=418, 82.1%) with those having second or more recurrent episodes of urinary tract infection (n=91, 17.9%). Results The mean age of children with a single episode of urinary tract infection was significantly lower than those who had recurrent urinary tract infection (5.33±4.38 vs. 7.01±4.83 years, p=0.003). Incidences of Escherichia coli and Enterococcus faecalis was significantly higher in patients with recurrent urinary tract infection than those who had single episode (n=315, 75.4% vs. n=80, 87.9%, p=0.009 and n=8, 1.9% vs. n=9, 9.9%, p<0.001, respectively). An abnormal ultrasound was significantly more common in patients with recurrent urinary tract infection than those who had a single episode (n=41, 54.6% vs. n=59, 22.7%). Increased renal parenchymal echogenicity (p=0.002), bladder cystitis (p=0.01) and hydronephrosis (p<0.001) were significantly more common in patients with recurrent urinary tract infection than those who had a single episode of urinary tract infection. Conclusion Escherichia coli and Enterococcus faecalis were the most common responsible pathogens in recurrent urinary tract infections. Structural changes, such as hydronephrosis and bladder cystitis, are likely to have an important role in the etiology of children with recurrent urinary tract infection.

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“…2 A similar UTI prevalence of 5.6% for the DUTY study urine samples overall in NHS laboratories was found. 18 Fever was not an inclusion criterion in that study or in the present study. However, a systematic review of 10 studies, eight of which were conducted in a hospital ED, with one in a clinic and ED setting, and one in a clinic setting, and all conducted in the US apart from a clinic study in Taiwan, found a UTI prevalence of 7% among infants presenting with fever.…”

Section: 23mentioning

confidence: 99%

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study

et al. 2016

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Acutely unwell children <5 years presenting to 233 UK primary care sites. MethodLogistic regression to identify independent associations of symptoms, signs, and urine dipstick test results with UTI; diagnostic utility quantified as area under the receiver operator curves (AUROC). Nappy pad rule characteristics, AUROC, and contamination, compared with findings from clean-catch samples. ResultsNappy pad samples were obtained from 3205 children (82% aged <2 years; 48% female), culture results were available for 2277 (71.0%) and 30 (1.3%) had a UTI on culture. Female sex, smelly urine, darker urine, and the absence of nappy rash were independently associated with a UTI, with an internally-validated, coefficient model AUROC of 0.81 (0.87 for clean-catch), which increased to 0.87 (0.90 for clean-catch) with the addition of dipstick results. GPs' 'working diagnosis' had an AUROC 0.63 (95% confidence intervals [CI] = 0.53 to 0.72). A total of 12.2% of nappy pad and 1.8% of cleancatch samples were 'frankly contaminated' (risk ratio 6.66; 95% CI = 4.95 to 8.96; P<0.001). ConclusionNappy pad urine culture results, with features that can be reported by parents and dipstick tests, can be clinically useful, but are less accurate and more often contaminated compared with clean-catch urine culture.

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Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Cited by 21 publications

References 9 publications

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial

Comparison of Primary and Recurrent Urinary Tract Infections in Children

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study

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