The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé.
CASE
V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew >100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile.
Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.
