InfecciÓn urinaria en un Servicio de Pediatría, distinciÓn de grupos y diferentes modos de presentaciÓn clínica

Introduction and pulpose: urinary tract infection (UTI) is a frequent clinical problem in pediatric practice which shows a wide range of variation. Determination of the predominant clinical presentation of UIT in our environment, knowing the aetiology and epidemiology of UTI in pediatric patients, evaluating prevalent agents and its antibiotic sensibilities, and establishing of relationships between pyuria and urocultures, were main objectives of this study. Materials and methods: according inclusion criteria (febrile syndrome without focal manifestation, neonatal sepsis, growing curve stopping, urological signs and symptoms) urocultures were obtained in 63 children in a prospective study. Distribution according age and gender groups, clinical presentation, prevalent microorganisms and its sensibilities were studied. Results: urocultures confirmed UTI in 27 children (42%). Mean age: 2 years 5 months old, range 28 days to 9 years old. 12 cultures of 27 were found positive in children less than 1 year old (44.4%), with male predominance (M:F ratio = 2:1) A similar frequency was found in children of 1 to 5 years old, with female predominance (M:F= 1:5) 9 urocultures were ordered in children older than 6 years old, 3 of them were positive, all female. Febrile syndrome without focal manifestation showed a sensibility and positive predictive value (PPV) of 26%. Growing curve stopping showed 30% sensibility and 61% PPV Fever associated urological signs and symptoms showed 33% sensibility and 90% PPV. Pyuria showed 71% sensibility and 76% PPV. E. coli were cultured in 74% followed by P. mirabilis (7,4%) and other less frequent germs. Isolated E. coli colonies showed 100% sensibility to nitrofurantoin, 55% to first generation cephalosporine and 31,2% to ampicillin. Conclusion: UTI clinical manifestations varies according age of presentation. Before a child with fever associated urological signs and symptoms, a poor weight-gaining toddler or febrile syndrome without focal manifestation, urocultures should be ordered to rule out UTI, avoiding not only underdiagnosis, that might occult associated malformations with subsequent renal function deterioration, but also overdiagnosis that might imply performing unnecessary procedures.