Urinary Tract Infection (UTI)

Kumud P Mehta
Urinary Tract Infection (UTI) - Diagnosis
The gold standard for diagnosis of UTI is urine culture, colony count and antibiotic sensitivity report in a clinical setting of UTI. The collection of urine under sterile conditions is an important point to remember. In very young infants, suprapubic bladder aspiration and in females or infants, use of urinary collection bags may be needed.

In older children midstream clean catch collection of urine in a sterile container and sending it within an hour or two to the lab are important points to get an accurate diagnosis of UTI. Presence of pus cells (more than 10/ HPF in males and 25/hpf in female children) and gram staining of fresh sample of urine for gm-ve bacilli support the diagnosis of UTI. 50% of cases of UTI may not have pyuria.

There are chemical tests like a) leukocyte esterase test and b) nitrite test, which can be used as screening test for UTI but the gold standard, is urine culture even in these children.

Since there is a high incidence of congenital obstructive and non obstructive malformations of kidney and urinary tract in 50-75% of infants with UTI, early diagnosis of these malformations is useful in preventing permanent kidney damage which occurs if congenital defects + UTI combine. Hence every child with UTI below the age of 3 years should be investigated as follows:
1) USG of kidneys, pelvicalyceal system, ureter and urinary bladder to detect dilatation (hydronephrosis, hydroureter, distended bladder and residual urine) which denotes either obstruction in subvesical region or VU reflux.
2) To detect the site of obstruction (like PU valves) or reflux, MCU should be performed in every child below the age of 2-3 years with UTI. It is done 3 - 6 weeks after the acute episode is over. Above the age of 3 years, MCU is indicated in those children with abnormal USG findings or renal scars detected on Tc DMSA renal scan which is the 3rd imaging test in a child with UTI. DMSA renal scan is ideally done 3 - 6 months after the acute episode is over. The aim of Tc99 DMSA renal scan is to detect acute infection of kidney and subsequently after 3-6 months of pyelonephritis to detect permanent renal scars.

Urinary Tract Infection (UTI) Urinary Tract Infection (UTI) 01/02/2002
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