The Linkage between Urine pH and Major Uropathogens in Children with Urinary Tract Infections

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Description

One of the most typical paediatric illnesses worldwide is Urinary Tract Infection (UTI). In a meta-analysis of 18 studies, the combined prevalence of UTI was 7.8% among children aged 0 to 19 years and 7.4% among febrile infants aged 0 to 24 months. The nonspecific symptoms and indicators of UTI make an early diagnosis difficult, especially in new-born’s and young children. Leukocyte Esterase (LE) or White Blood Cells (WBCs) in the urinary sediment are infection- specific indications, whereas specific gravity and pH are chemical features that may be determined using Urine Analysis (UA), which is a useful diagnostic technique. Many researches have tried to forecast culture results based on UA results. However, depending on urinary nitrite, LE, or leukocyte counts, the prediction performance for certain infections are still subpar. Although UA by itself cannot be used to specifically identify uropathogens, it can be used to direct empirical antibiotics and track clinical response. Urine pH is one of the crucial factors that have been left out of earlier studies on the identification of uropathogens. According to custom, the pHs of acidic, average, and alkaline urine are 4.5–5.5, 5–6, and 6.5-8, respectively. 7 Different bacteria may possess specific uropathogenic traits that interact with host elements and produce urine with varying levels of acidity. For instance, urea-splitting organisms like Proteus species and Pseudomonas aeruginosa have been demonstrated to be related with higher urine pH despite the absence of strong epidemiological data. Morganella morganii and Staphylococcus aureus raised the urine pH to 7.4 and 6.9, respectively, in a lab model, while Proteus mirabilis, Proteus vulgaris, and Providencia rettgeri could only raise the urine pH to a maximum of 6.4. Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Serratia marcescens. Even a urine pH of >7.5 has been linked to UTIs, according to one study. Such anecdotal information from novels and journal articles hardly ever cites scientific research. There isn’t much information on the relationship between uropathogens and urine pH. In the current work, we thoroughly examine the range of urine pH in urine specimens across age, sex, and prevalent uropathogens. In order to shed light on the function of urine pH in identifying uropathogens and risk management in paediatric UTI, we also offered, for the first time, epidemiological evidence based on a large sample size. Urinary Tract Infections (UTIs) are the first clinical sign in up to 30% of children with urinary tract abnormalities. Early diagnosis, appropriate treatment, and recommendations for additional imaging in these patients may prevent future UTIs and eventually renal function loss. While prenatal or postnatal ultrasound is most frequently used to identify urinary system defects involving hydro nephrosis, the diagnosis of Vesicoureteral Reflux (VUR) typically depends on the work-up carried out after a Urinary Tract Infection (UTI). According to the most recent EAU/ ESPU guidelines, depending on sex, age, and clinical presentation, Voiding Cystourethrogram (VCUG) or Dimercaptosuccinic Acid (DMSA) scanning is advised following the first episode of febrile UTI due to the potential of renal scarring. However, a proper diagnosis of this UTI is necessary to determine the appropriate justification for additional testing following a febrile UTI. The only sign of a UTI, particularly in young children and new-born’s, may be fever. Fever is the primary symptom in 5.3–7% of children who have a UTI. It is widely acknowledged that accurate urine collection techniques are essential for the diagnosis of febrile UTIs, especially in patients typically infants where the diagnosis is primarily made based solely on the results of a urine culture and urine findings, with no additional specific clinical symptoms. Bag urine specimens, despite their widespread use, have been demonstrated to be prone to contamination and to have very low specificity for the diagnosis of UTIs. Bag urine is therefore only advised for UTI exclusion and is not considered sufficient for the diagnosis of UTIs. Additionally, the contamination that might occur when using bag urine can lead to false antiprograms and the inappropriate antibiotic treatment plan. In younger children, catheterization and Suprapubic Aspiration (SPA) are the two most common techniques of collecting urine. For older children, clean-catch urine may be an appropriate alternative approach with adequate correlation of urine culture data. Although only in uncircumcised boys and with fewer colony-forming units, catheterized urine samples are just as susceptible to Contamination as Bag Urine Samples (CFUs).

Conclusion

Despite these widely accepted facts, a lot of UTIs in kids are only identified by bag urine and the absence of other distinct symptoms. One could argue that these youngsters shouldn’t be probed further until they experience a correctly diagnosed febrile UTI because referral diagnosis for further examination rely thereon on potentially false-positive urine cultures. We predicted that initial diagnoses using potentially contaminated urine samples would have lower rates of VUR than those utilising precise urine collection methods. If so, using bag urine at the first diagnosis should result in a more limited indication of additional work-up with VCUG, and the urine-sampling approach may be employed as a deciding element in the indication for VCUG.