Bacteriuria in children attending a primary health care clinic: a prospective study of catheter stream urine samples.

Urinary tract infection (UTI) in infancy and childhood has received scant attention at primary health care (PHC) level, rarely featuring as one of the common diseases. In a prospective study conducted at a PHC clinic, 16 of 94 children (17%) from whom urine was collected by strict aseptic catheterization had bacteriuria (BU). Twelve of these had associated leucocyturia (> 5 WBC/HPF). The median age of those with BU was 9 months (range 1-30 months). BU rarely occurred in isolation (6%), but was most often detected in association with acute respiratory infection (43%) and acute diarrhoea (19%). No association of BU with mild malnutrition was detected in the 50% of children who were underweight for age. Gram-negative pathogens accounted for 14 cases (87.5%). These pathogens were resistant to commonly recommended antibiotics for UTI. Only five cases of BU returned for follow-up at 3 months; no abnormalities were detected on repeat catheter urine samples, urinary tract ultrasonography, voiding cystourethrogram and DMSA studies in them. From these and other findings we conclude that BU is probably often present in young children with common diseases attending PHC centres in developing countries. Further studies are required to establish exactly the role these pathogens play in the pathogenesis of UTI.