Comparison of Ultrasound-guided Suprapubic Aspiration with Urethral Catheterization in Infants

PURPOSE: Suprapubic aspiration(SPA) has been considered the "gold standard" for obtaining urine in non-toilet trained infants. Ultrasound(US)-guided SPA improves the success rate of the procedure and reduces the complications. However, many physicians perceive SPA as invasive and prefer the use of urethral catheterization (Ucat). We compared the success rate, complications and accuracy of US-guided SPA and Ucat. METHODS: 121 infants who visited Ewha Womans University Mokdong Hospital with suspected urinary tract infection(UTI) were investigated. For the first study, the study infants were randomly assigned to either the US-guided SPA(n=32) or Ucat(n=32) groups. The success rate and complications of both procedures were compared. For the second study, US-guided SPA and Ucat were performed simultaneously(n=57). The accuracy of urethral catheterization was subsequently analyzed. The criteria for success was defined as the collection of more than 0.5 mL of urine. UTI was diagnosed by the presence of uropathogens over 105 colony-forming units(CFU)/mL. RESULTS: The overall success rate of the US-guided SPA was 96.9%(71.9% in first attempts, 25.0% in second attempts) which was not significantly different compared to 96.9%(90.6% in first attempts, 6.3% in second attempts) in the Ucat(P>0.05) group. The aspirated urine volume was 7.4+/-3.7 mL in the US-guided SPA group, which was not significantly different to 4.5+/-2.6 mL in the Ucat(P>0.05) group. The accuracy of Ucat in comparison to the US-guided SPA was low with sensitivity 59.5%, specificity 86.6%, false-positive rate 13.3% and false-negative rate 40.5%. CONCLUSION: US-guided SPA should be encouraged as the best method to collect the urine in non-toilet trained infants with UTI.

Causative Organisms of Urinary Tract Infection in Children, and their Antibiotic Susceptibility / 소아과

PURPOSE: In caring patients with urinary tract infection(UTI), it is prominent to know causative agents and their antimicrobial susceptibilities, of which domestic data appear somewhat different from those reported in the literature. The study was done to learn the distribution of pathogens causing UTI and their antimicrobial susceptibilities in Korean children. METHODS: One hundred forty two inpatients diagnosed with symptomatic UTI in the Department of Pediatrics, Hanyang University Hospital from 1997 to 2002 were retrospectively enrolled to analyze relevant information obtained from medical records, including causative agents of UTI and their antimicrobial susceptibilities. RESULTS: The average age of the study patients was 1.9 years with the peak in infants younger than 1 year of age(105 patients), of which 84 patients were younger than 6 months of age. The male to female ratio was 4:1 in or =1 year of age. Isolated organisms in urine cultures included Escherichia coli 83.1%, Klebsiella pneumoniae 6.3%, Proteus mirabilis 2.1%, and their distributions were not different, whether suprapubic specimen(100 patients) or non-suprapubic specimen(42 patients) was cultured. Antimicrobial susceptibility of E. coli was above 90% against ceftriaxone, ceftazidime, amikacin, 40-65% against trimethoprim-sulfamethoxasole, tobramycin, gentamicin, and 16.9% against ampicillin. CONCLUSION: E. coli was isolated in 83.1% of children with UTI, which is comparable to the data in the literature. The fact that susceptibility of E. coli was low to ampicillin, gentamicin, and trimethoprim-sulfamethoxasole indicates that the empiric and prophylactic choices of antimicrobials for UTI in Korean children should be investigated further.