ESPN 51th Annual Meeting

ESPN 2018


 
CLINICAL RELEVANCE OF NON E COLI URINARY TRACT INFECTION (UTI) IN CHILDREN – A PROSPECTIVE STUDY
SING MING CHAO yong hong ng indra ganesan

1- KK Hospital
 
Introduction:

Non E Coli UTI constitutes 10- 20% UTI in young children. Its association with acute pyelonephritis (APN), underlying vesicoureteric reflux (VUR) and subsequent renal scarring (RS) can be of important relevance in clinical management.

Material and methods:

This is a prospective study of a cohort of patients diagnosed with febrile UTI, based on an established hospital clinical pathway for patients > 1 month old. Informed consents were taken. Catheterized urine were obtained in infants who required early treatment while mid-stream urine were obtained in others. Antibiotic treatment was based on antibiogram. DMSA scans done within 5 days of treatment and follow up DMSA scans done at 6 months post-infection were used to diagnose APN and RS respectively. MCU was done 3-4 weeks after antibiotic treatment.

Results:

121 patients were recruited, 88.7% being < 12 months, with a slight male predominance (1.3:1). E coli was cultured in 107 patients while 14 patients (11.6%) had non E Coli infections. DMSA done in 113 patients showed 62 with APN, of which 53 and 9 were E Coli and non E Coli infections respectively yielding p value < 0.45(not significant). MCU done in 96 patients showed 17 patients with VUR, of which 10 and 7 had E Coli and non E Coli infections respectively with p < 0.0006 (highly significant). Follow up DMSA was done in 53 patients. RS was seen in 24 patients, of which 15 and 9 patients had E Coli and non E Coli infections with p< 0.96 (not significant)

Conclusions:

Non E Coli UTI in young children was a significant risk factor for underlying VUR and may serve as an indication for MCU. Risk of APN and RS appeared to be not significantly associated with Non E Coli infections which may explain why APN and RS can be seen in many patients without underlying VUR.