Læknablaðið - 15.02.1994, Blaðsíða 26

68
LÆKNABLAÐIÐ
oft sársaukafullar fyrir börn, auka hættu
á þvagfærasýkingu vegna ýmissa aðgerða
(blöðrumynd og blöðruspeglun) og valda
auk þess foreldrum fjárhagslegu tjóni vegna
fjarveru frá vinnu. Því ber læknum að vanda
vel til þvagsýnatöku hjá ungum börnum og
staðfesta þvagfærasýkingu, annað hvort með
ástungu- eða þvagleggsþvagi.
SUMMARY
Urinary tract infections in infants are common.
Unrecognized and untreated infections can have
serious consequences to the kidneys and can cause
serious diseases later in life. Urine specimens are
often obtained by adhesive bags in young children
and infants. The purpose of this study is to explore
the diagnostic value of urinary bag specimens in
diagnosing urinary tract infection in infants.
One hundred infants were studied prospectively at
the Pediatric Department of the University Hospital
in Iceland regardless of underlying diagnosis.
Urinary tract infection was confirmed in 7 children
by either a supra-pubic aspirate or a catheter
specimen. Thirty children had contaminated bag
specimens.
Mulitvariate regression analysis revealed that
microscopic bacterial and white blood cell count
correlated best with urinary tract infection (r: 0.42
and r2 change: 0.15 respectively, p< 0.05) but a
culture of the bag specimen correlated poorly ( r2
change: 0.03, p<0.05). Using bacterial count of
100.000 per ml. in a bag specimen as a cut off
value, had a positive predictive value of only 46%
but a negative predicive value of 99%.
It is concluded that a bag specimen cannot be
used reliably in diagnosing urinary tract infection
in infants. A properly collected urine by either a
supra-pubic aspirate or a catheter should be used
for diagnostic purposes.
HEIMILDIR
1. Winberg J, Andersen H, Bergström T, et al.
Epidemiology of symptomatic urinary tract infection
in childhood. Acta Paediatr Scand 1974; 252/Suppl.
nr: 1-20.
2. McCracken GH Jr. Diagnosis and management of
acute urinary tract infections in infants and children.
Pediatr Infect Dis J 1987; 6: 107-12.
3. Siegel SR, Siegel B, Sokoloff BZ, et al. Urinary
infection in infants and preschool children. Am J Dis
Child 1980; 134: 369-72.
4. Rapkin RH. Urinary tract infection in childhood.
Pediatrics 1977; 60: 508-11.
5. Jodal U. The Natural History of Bacteriuria in
Childhood. Infect Dis Clin North Am 1987; 1: 713-
29.
6. Stull TL, LiPuma JJ. Epidemiology and natural
history of urinary tract infections in children. Med
Clin North Am 1991; 73: 287-97.
7. Smellie JM, Ransley PG, Normand ICS, et al.
Development of new renal scars: A collaborative
study. Br Med J 1985; 290: 1957-60.
8. Wettergren B, Jodal U, Jonasson xy. Epidemiology of
bacteriuria during the first year of life. Acta Paediatr
Scand 1985; 74: 925-33.
9. Haycock GB. Investigation of urinary tract. Arch Dis
Child 1986; 61: 1155-8.
10. Jacobson SH, Eklof O, Eriksson CG, Lins LE,
Tidgren B, Winberg J. Development of hypertension
and uremia after pyelonephritis in childhood: 27 year
follow up. Br Med J 1989; 299: 703-6.
11. Stork JE. Urinary tract infection in children. Adv
Pediatr Infect Dis 1987; 2: 115-34.
12. Shad KJ, Robins DG, White RHR. Renal scarring and
vesicoureteric reflux. Arch Dis Child 1978; 53:
210-7.
13. Rolleston GL, Maling TM, Hodson CJ. Intrarenal
reflux and the scarred kidney. Arch Dis Child 1974;
49: 531-9.
14. Durbin WA JR, Peters G. Management of urinary
tract infections-in infants and children. Pediatr Infect
Dis J 1984; 3; 564-74.
15. Ogra PL, Faden HS. Urinary tract infections in
childhood: An update. J Pediatr 1985; 106: 1023-9.
16. Edelmann CM Jr, Ogwo JE, Fine BP, Martinez
AB. The prevalence of bacteriuria in full term and
premature newbom infants. J Pediatr 1973; 82: 125-
32.
17. Schlager TA, Dunn ML, Dudley SM, Lohr JA.
Bacterial contamination rate of urine collected in a
urine bag from healthy non-toilet-trained male infants.
J Pediatr 1990; 116: 738-9.
18. Sýkingavamamefnd Lsp. Leiðbeiningar um
miðbunuþvagtöku. Desember 1990.
19. Friedman GD. Primer of epidemiology. 3rd ed. New
York: McGraw-Hill, 1987: 261-2.
20. Cannon HJ Jr, Goetz ES, Hamoudi AC, Marcon MJ.
Rapid screening and microbiologic processing of
pediatric urine specimens. Diagn Microbiol Infect
Dis 1986; 4: 11-7.
21. Lohr JA. Use of routine urinalysis in making a
presumptive diagnosis of urinary tract infection in
children. Pediatr Infect Dis J 1991; 10: 646-50.
22. Lohr JA, Portilla MG, Geuder TG, Dunn ML, Dudley
SM. Making a presumptive diagnosis of urinary tract
infection by using a urinalysis performed in an on-
site laboratory. J Pediatr 1993; 122: 22-5.
23. Shaw KN, Hexter D, McGowen KL, Schwartz JS.
Clinical evaluation of a rapid screening test for
urinary tract infections in children. J Pediatr 1991;
118: 733-6.
24. Weinberg AG, Gan VN. Urine screen for bacteruria
in symptomatic pediatric outpatients. Pediatr Infect
Dis J 1991; 10: 651-4.
25. Aronson AS, Gustafson B. Svenningsen NW.
Combined suprapubic aspiration and clean voided
urine examination in infants and children. Acta
Pediatr Scand 1973; 62: 396-400.