Urinary Tract Infection in Boys Less Than Five Years of Age: A General Pediatric Perspective.

OBJECTIVES: To examine the pattern of urinary tract infection (UTI) in boys < 5 years admitted to general pediatric wards and to identify the approach to imaging investigations. DESIGN: During the period from January 2002 through December 2002, 34 boys < 5 years of age were admitted to Farwania Hospital with UTI. Age at diagnosis, presenting features, urinalysis, pathogens, acute phase reactants and imaging procedures were reviewed for these patients. RESULTS: All 34 patients in this study were less than one year. Fever was the most common presenting feature and was seen in 70.6% of patients. Pyuria was found in 77% , positive leukocyte esterase (LE) test in 85.7% and positive nitrite test in 45.7% of patients. Significant leukocytosis was found in 39.3%, high C-reactive protein (CRP) in 46.8% and high erythrocyte sedimentation rate (ESR) in 50% of children. Escherichia coli (E.coli) were the most common pathogen affecting 77.1% patients. Radiological investigations were recommended as follows: ultrasound scan (US) for all patients (94.2% did the test, 46.8% had normal scans and 43.7% had dilatation of pelvicalyceal system); Early-scheduled (99m)Tc dimercaptosuccinic scan (DMSA) was done in seven patients. Five or 71% had evidence of acute pyelonephritis; Late-scheduled DMSA was recommended for 25 patients. Only 52% did the test and out of those 46% had evidence of chronic involvement of the kidney(s); Micturating cystourethrogram (MCUG) was advised for 32 patients. 43.8% failed to carry out the procedure. Vesicoureteric reflux (VUR) was found in 38.8% of those who performed the test. CONCLUSION: Unexplained fever in young boys should suggest UTI. Absence of fever does not exclude UTI, if other suggestive features exist particularly in the very young. UTI is commonly suggested by findings on urinalysis, on the other hand, negative urinalysis should not exclude the infection. Empiric antibiotics should cover gram-negative bacilli. Innovative strategies to ensure compliance to radiological investigations are needed.