Pediatrics: New method can quickly treat urinary tract infections in children

Pediatrics: New method can quickly treat urinary tract infections in children.  In order to diagnose a urinary tract infection, the doctor must culture a urine sample and wait for it to grow bacteria in a petri dish containing nutrients.

A study led by researchers from UT Southwest and Child Health defined the number of white blood cells that must be present in children’s urine at different concentrations to reveal the risk of urinary tract infection (UTI). This discovery was recently published in the journal Pediatrics and can help speed up the treatment of this common disease and prevent potential lifelong complications.

Among children under 24 months of age, UTI accounts for 7% of fevers and is a common factor in hospital emergency room visits. However, the study leader, UTSW Assistant Professor of Pediatrics, emergency physician and pediatric nephrologist at Dallas Children’s Medical Center, Dr. Shahid Nadeem, said that because symptoms are similar to other conditions that cause fever, accurate diagnosis is often difficult.

He explained that if the diagnosis is delayed, UTI may develop into a serious infection, which may have lasting consequences. For example, kidney scarring associated with urinary tract infections is associated with hypertension and chronic kidney disease later in life.

In order to diagnose a urinary tract infection, the doctor must culture a urine sample and wait for it to grow bacteria in a petri dish containing nutrients. However, Nadeem said this process can take up to two days, delaying treatment. Therefore, he and other doctors usually rely on testing for white blood cell-related proteins (called leukocyte esterase (LE)) in the urine and then identify them by looking for white blood cells (a marker of immune activity) in the urine. The presence.

He added that in children, the number of white blood cells may be highly variable, and some of these changes may be caused by changes in urine concentration. Therefore, it is not known which white blood cell count threshold should be used based on urine concentration to start treatment of potential UTI.

To determine these parameters, Nadeem and his colleagues searched the medical records of children under 24 months of age who were taken to the emergency room of the Children’s Medical Center between January 2012 and December 2017, suspected of having UTI, and Urinalysis was performed-in which the urine was evaluated for the concentration of LE and the presence of LE and white blood cells-and urine culture was performed. The search found 24,171 patients, of which 2,003 were diagnosed with UTI based on urine culture.

Using the specific gravity of their urine (the density of water in the urine as a proxy for concentration) and the number of white blood cells present in the field of high-power microscopy, the researchers arrived at the critical point of urine. Three urine concentration groups: For low urine concentration, children only need 3 white blood cells to suspect urinary tract infection; for medium concentration, the number is 6; for high concentration, it is 8.

Nadeem said that for each concentration group, the white blood cell esterase remained constant-suggesting that this is a good trigger for analyzing the presence of white blood cells in the urine.

He added that understanding how many white blood cells are often present in the urine of different concentrations of urine in children with urinary tract infections can help doctors start treating these infections before they become infected. This can reduce the burden on patients and their parents and prevent complications. disease. “The sooner we start treatment, the better for these young patients,” Nadeem said. “Our results add more information to the physician’s toolbox to make this decision.”

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