Evaluation of Clinical and Laboratory Findings of Patients Hospitalized for Urinary Tract Infection

Abstract

Introduction: Urinary tract infections (UTIs) are common and important because of their long-term consequences in child- hood. The treatment of UTI consists mainly of antimicrobial agents to eliminate the symptoms, to prevent urosepsis, and to reduce the likelihood of renal damage. Here, we aimed to evaluate the clinical, laboratory findings of children hospitalized for UTI, in a 3-year period. Methods: Hospital records of the patients were investigated retrospectively. Data about demographic features, past and family history, clinical and laboratory findings, urine sampling methods, microorganisms isolated from urine culture, treat- ment duration, and recurrent hospitalization data were collected. Urinary system imaging (USG), dimercaptosuccinic acid scintigraphy, and voiding cystourethrography findings were obtained. Results: We enrolled 201 children aged between 1 month and 18 years (median age: 10 months) to our study. About 45.8% of children had urinary tract anomalies. The presence of recurrent UTI, congenital anomaly, and vesicoureteral reflux was 26.4%, 8.5%, and 8.5%, respectively. The most common symptoms were fever (54.2%), vomiting (22.9%), and dysuria (12.4%). Upper urinary tract involvement rate was 45.3%. Fever was observed in children with upper UTI significantly (p=0.0001) more than in children with lower UTI, while jaundice (p=0.004) and restlessness (p=0.039) were observed more in lower UTI than in upper UTI. Escherichia coli was the most isolated agent from urine cultures (74.6%). About 26.9% of cases (n=54) had pathologic urinary sonography (USG) findings. About 53.7% and 55.2% of cases had 99m Tc-DMSA scintigraphy and VCUG, respectively. Thirty-one cases with DMSA and 32 cases with VCUG had pathologic findings. Mean duration of treatment was 8.48±1.94 days. Discussion and Conclusion: Urinary tract infections should be in differential diagnosis of infants with fever and vomiting. Appropriate antimicrobial and supportive treatment, urinary tract imaging studies, in relevant cases, multidisciplinary treat- ment, and follow-up are the main steps of UTI management. Treatment should be aimed according to resistant microorgan- isms in cases with urinary tract anomalies. Before initialization of treatment, urine culture should be done. Cases with renal scarring should be followed up for long-term complications.