Difficulties in diagnosing urinary tract infections in small children

Abstract

Urinary tract infections (UTIs) in children appear to be simple and straightforward matters, but there is as yet no consensus on UTIs in this patient group, and it remains one of the most -if not the most -controversial fields in paediatric medicine. Controversy and the lack of consensus can be found in many areas, including the diagnosis and management of UTIs in paediatric patients. Consequently, children with a UTI are investigated and treated quite differently in different parts of the world and also within different parts of the same country. One factor contributing to the current situation is the unexpected difficulty in diagnosing a UTI in children. This difficulty has implications not only for clinical work but also for scientific studies. Substantial over-and under-diagnosing can result from practical difficulties in at least three areas, including problems with collecting urine samples, in interpreting bacterial numbers correctly, and in confusing infantile asymptomatic bacteriuria and a true symptomatic febrile UTI. In this review, these problems will be discussed in detail as well as the implications they have had on clinical practice and research on UTIs.

Urine Contamination in Nontoilet-trained and Uncircumcised Boys

“…We elected to study uncircumcised boys because they represent the most common part of the population in our country, and are also a population with a high risk of urine contamination when urine collection is required. Previous data has shown that the expected rate of asymptomatic bacteriuria in uncircumcised boys in the first year of life is only 2.5% [12]. A high contamination rate has previously been observed, particularly in uncircumcised boys, using both the catheter and clean void methods [13].…”

Évaluation des pratiques de prise en charge des infections urinaires de l’enfant

“…Bien que son usage dans les SAU pédiatriques n'ait pas été banni de certaines recommandations européennes [3,12,19], le sachet collecteur induit un risque plus important de contamination significative du prélèvement par les bactéries périnéales ou urétrales [20]. Sa spécificité est en effet de seulement 14 à 84% selon les études, alors que d'autres modes de recueil ont une spécificité bien meilleure (99% pour le sondage urétral) [4].…”

Infección urinaria en pediatría: controversias

“…Como menciona el doctor Kjell Tullus en un reciente comentario editorial en una prestigiosa revista científi ca "la infección urinaria en niños es uno de los, si no el más controvertido campo de la medicina pediátrica" 63 . La incorporación de nuevas y mejores técnicas diagnósticas, de agentes antimicrobianos de acción más prolongada y con menor toxicidad, y una mayor racionalidad en la forma en que hacemos el seguimiento de estos niños, todas materias de análisis por medicina basada en evidencias, han hecho que muchos dogmas en relación a esta patología, varios de los cuales publiqué en mi anterior artículo 1 , se hayan derrumbado o estén, al menos, en franca discusión.…”