Genitourinary Abnormalities in Children with Urinary Tract Infections

Authors: Ayşe BALAT, L. Leighton HILL

Abstract: Urinary-tract infections (UTI) are common infectious diseases in childhood. The presence of UTI may be an indicator of a serious genitourinary (GU) abnormality that requires medical intervention. We retrospectively reviewed the charts of children discharged with a diagnosis of UTI from the Texas Children's Hospital, Houston, Texas, between July 1, 1991 and June 30, 1994. The purpose of the study was to determine how many patients had underlying GU abnormalities, the specific type of abnormality, and the microorganism causing the UTI. During the 3-year period, there were 48,382 discharges from the hospital, and 1,221 (2.5%) of those discharges were patients with UTI. Of the 1,221 cases of UTI, one hundred thirty-seven acquired the disease nosocomially and were not included this study leaving 1,084 with first-time or recurrent infections. Of the, 1,084 patients, 806 underwent radiologic evaluation, and 275 (34.1%) of 806 had underlying GU abnormalities. There were 167 girls and 108 boys ranging in age from 7 days to 18 years (mean age: 5.7 years). The percentage of abnormalities found in girls (35.4%) was similar to the percentage found in boys (32.8%). The distribution of abnormalities showed some changes by age and sex. Lower urinary-tract abnormalities were common in children older than 3 years of age (43.5% vs 20.5%, P<0.001). Vesico-ureteral reflux was common in children below 3 years of age (51.6% vs 25%, P<0.001). Lower urinary-tract abnormalities were higher in boys (41.7% vs 24%, P<0.001). Lower urinary-tract abnormalities were higher in boys (41.7% vs 24%, P<0.001), whereas the percentage of vesico-ureteral reflux was higher in girls (47.4% vs 27.3%, P<0.001). The distribution of upper urinarytract abnormalities or combined abnormalities was similar for both sexes. Renal scarring was found more often in children with reflux than in children without reflux (14% vs 1.9%, P<0.05). The most common microorganism was Escherichia coli; the second common microorganism was Pseudomonas. There were no differences in the microorganism pattern in patients with and without GU abnormalities. Our finding that more than one-fourth of the UTI patients in our study group had a underlying GU abnormality is significant and provides support for early intervention to identify and treat these complications that could cause serious, irreparable kidney damage.

Keywords: Genitourinary abnormality, urinary tract infections.

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