Asymptomatic urinary tract infections (bacteriuria and leukocyturia) in children. Two cases and review of the literature

Background: Asymptomatic urinary tract infection is defined as significant bacteriuria and leukocyturia without clinical symptoms of urinary tract inf ection, without functional disturbance of the urinary bladder and inflammat ory signs in blood. Many studies demonstrated that antibiotic treatment is not recommended for children with asymptomatic bacteriuria. Treatment of ch ildren with asymptomatic urinary tract infection is discussed controversely . Patients:We report on 2 girls (8 and 10 years old) who had pyelonephritis a nd vesicoureteral reflux in early childhood. Primary reflux in one patient was surgically repaired. In the other spontaneous resolution of reflux was observed. At schoolage recurrent asymptomatic bacteriuria and leukocyturia was seen. In patient 1 Proteus mirabilis and E. coli, and in patient 2 Pseu domonas aeruginosa were found in urine. Both children were treated with ant ibiotics several times. Many recurrences of bacteriuria and leukocyturia we re seen. At that time, another voiding cystourethrogram showed no reflux in both children. We stopped antibiotic therapy and 2 years later, urine cult ures were negative. Symptomatic urinary tract infections were not observed in the following two years and urine cultures became negative. Ultrasonic e xaminations of the bladder and kidneys were normal. Conclusions: Antibiotic treatment of children with asymptomatic urinary tra ct infection (bacteriuria and leukocyturia) is not necessary provided that there are no signs of renal damage, reflux, bladder dysfunction or inflamma tory signs in blood. Ultrasonic controls of bladder and kidneys are recomme nded.