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UTI: Diagnosis and Evaluation in Symptomatic Pediatric Patients

Department of Pediatrics, Johns Hopkins University School of Medicine, John Hopkins Hospital, Baltimore, Maryland; Pediatric Renal Clinic, St. Agnes Hospital, Baltimore, Maryland

Michael A. Barone, MD

Department of Pediatrics, Johns Hopkins University School of Medicine, John Hopkins Hospital, Baltimore, Maryland; Department of Medical Education, St. Agnes Hospital, Baltimore, Maryland

Ethan Spiegler, MD

Department of Radiology and Nuclear Medicine, John Hopkins Hospital, Baltimore, Maryland; Department of Nuclear Medicine, St. Agnes Hospital, Baltimore, Maryland

We retrospectively reviewed data on 260 hospitalized pediatric patients with symptomatic urinary tract infection (UTI). To ascertain the colony-forming units (CFU) /mL compatible with the diagnosis of UTI, a culture from a catheterized urine specimen containing >1,000 CFU/mL was considered diagnostic of UTI and resulted in imaging by renal ultrasound, voiding cystourethrography, and renal nuclear scan with Tc99m dimercaptosuccinic acid (DMSA). A positive DMSA renal scan is indicative of pyelonephritis. We used logistic regression analysis to determine which patient characteristics were predictive of pyelonephritis. We determined that, in hospitalized pediatric patients, the colony count of the positive urine culture, the type of organism grown in culture, and the voiding cystourethrography (VCUG) result (positive or negative for vesicoureteral reflux) did not predict which patients had pyelonephritis. In females, advancing age of the patient and positive renal ultrasound results were predictive of which patients had pyelonephritis when we controlled for other factors. We feel this emphasizes the importance of a thorough evaluation of hospitalized symptomatic patients, including patients with colony counts of 1,000 to 50,000 CFU/mL, to locate the level of infection and plan appropriate therapy.

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