Incidence and outcome of symptomatic urinary tract infection in children.

The incidence of symptomatic urinary tract infection in 2879 children aged under 15 years was studied over 18 months in a single general practice. Infection was diagnosed if bacterial counts in three consecutive samples exceeded 100,000/ml. The incidence of urinary tract infection was 1.7 per 1000 boys at risk per year and 3.1 per 1000 girls. These values are lower than those of comparable studies, possibly because of the stricter diagnostic criterion used in the study. Urinary pus cell counts were also carried out and sometimes found to be misleading. Of the 14 children found to have an infection, three had a radiological abnormality. Five of the children had a recurrence of infection within the first two years, and one an asymptomatic bacteriuria seven years after diagnosis. Only six out of 34 children presenting with dysuria had infected urine, and an association was discovered between abacterial dysuria (or the urethral syndrome) in the remainder and a concurrent upper respiratory tract infection. All children should undergo radiological investigation after their first confirmed infection. Diagnosis and management could be improved by providing all general practitioners with a semiquantitative method of urine culture such as the dip slide.