From the Guidelines
For a 7-year-old with dysuria, nausea, positive blood and leukocytes on urinalysis, but a negative urine culture after UTI treatment, I recommend reevaluation for alternative diagnoses. The negative culture after treatment suggests either the antibiotics effectively cleared the infection before culture collection, or the symptoms were due to another condition mimicking UTI. Consider viral cystitis, chemical irritation from soaps or bubble baths, dysfunctional voiding, or vulvovaginitis in girls. Some key points to consider in the diagnosis and management of UTIs in children, as outlined in the American Academy of Pediatrics clinical practice guideline 1, include:
- The diagnosis of UTI is made on the basis of the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine.
- After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Complete the current antibiotic course if symptoms are improving. If symptoms persist, obtain a fresh urinalysis and culture before restarting antibiotics. Also evaluate for constipation, which can contribute to urinary symptoms in children. A thorough physical examination and detailed history of hygiene practices, voiding habits, and bowel movements are essential. Encourage increased fluid intake, proper wiping technique (front to back), regular voiding, and avoidance of irritants. If symptoms recur or persist despite these measures, consider referral to pediatric urology or nephrology to rule out anatomical abnormalities or vesicoureteral reflux, particularly if this represents a recurrent episode.
From the Research
Symptoms and Diagnosis
- The patient, a 7-year-old, presented with dysuria and nausea, and had positive blood and leukocytes in their urine, which are common symptoms of a urinary tract infection (UTI) 2.
- A urinalysis was performed, and the patient was treated for a UTI, but the culture was negative, which can occur in cases of asymptomatic bacteriuria or other non-infectious causes of dysuria 3, 4.
Possible Causes
- Dysuria can be caused by various factors, including UTIs, sexually transmitted infections, bladder irritants, skin lesions, and chronic pain conditions 3, 4.
- In children, UTIs are a common cause of dysuria, and Escherichia coli is the most common pathogen 2.
- Other possible causes of dysuria in children include urethritis, vaginitis, and non-infectious inflammatory causes such as a foreign body in the urinary tract or dermatologic conditions 4.
Treatment and Management
- The patient was treated for a UTI, but the negative culture result may indicate that the treatment was unnecessary or that the cause of the dysuria was non-infectious 2.
- Further evaluation and testing may be necessary to determine the cause of the dysuria and to guide appropriate treatment 3, 4.
- In children, it is essential to consider the possibility of recurrent UTIs and to provide guidance on prevention and management 2, 5.