Monitoring Health Care: Children with Bacteriuria

A program which used a nurse clinician to monitor the health care received by children with bacteriuria is described. We identified 152 patients with significant bacteriuria (greater than or equal to 10(5) organisms/ml) by urine culture from 351 patients who either had symptoms suggestive of urinary tract infections or routine urinalysis during health care visits. Adequate health care was provided to 116 (76%) of the 152 patients and inadequate health care to 31 (24%) of these patients. A significant number of patients who received inadequate therapy (12 of 36, or 37%) compared to 8 (7%) of 116 patients who received adequate therapy failed to clear their bacteriuria (Chi-square = 17, p less than 0.001). Eight patients with recurrent bacteriuria despite adequate therapy were shown to have no urinary tract anomaly by radiography. The use of recurrence of UTI as a criterion for measuring adequacy of therapy and the uniqueness of the program are discussed.