SYMPTOMATIC URINARY-TRACT INFECTION IN PRESCHOOL AUSTRALIAN CHILDREN

Objective: To describe the demographic and clinical features, short-te rm outcomes, microbiology and renal tract abnormalities of a cohort of young Australian children with symptomatic urinary tract infection. M ethodology: A total of 304 children <5 years with their first document ed symptomatic urinary tract infection who presented consecutively to the Emergency Department of a paediatric hospital between March 1993 a nd December 1994 and without a known predisposing cause were identifie d and details of their acute illness were recorded. Renal tract sonogr aphy, micturating cystourethrography and Tc-99 m dimercaptosuccinic ac id scintigraphy (DMSA) were routinely performed. Results: Of those who presented with urinary tract infection, 169 were boys and 135 girls; 64% were less than 1 year of age. For children from the local communit y, the cumulative incidence of urinary tract infection within the firs t 5 years of life was estimated to be 1.9% for boys and 1.8% for girls . There were no significant differences in illness characteristics acc ording to mode of referral or geographical locality. Presenting sympto ms were generally nonspecific and not referrable to the urinary tract. There were no deaths. One per cent of children required ventilatory s upport, and bacteraemia occurred in 6%, all of whom were under 6 month s of age. E. coli was the causal organism in 84%, and a high in vitro resistance to ampicillin/amoxycillin (54%) was demonstrated by the pat hogens isolated, Bacteriuria was eradicated in 99% with antimicrobial treatment. In this setting, the sensitivities of dipstick urinalysis ( leucocyte esterase +/- nitrites) and pyuria on microscopy (>10 x 10(6) white cells L-1) were 85%. Abnormal DMSA scintigraphy was detected in 39%, vesicoureteric reflux in 28%, and obstructive uropathy in 1%. Co nclusions: This study provides current and local data on a large sampl e of children <5 years with urinary tract infection, which are useful to clinicians who manage children at risk of the condition.