Pungent urine smell since couple of months for 9 months infant. Is this Urine infection ?

Patient

Q: My son is 9 months old. His Urine has pungent smell and he is Uncircumcised. We had done CUE and Urine Culture by collecting urine in a sterilized container.

CUE report showed normal, Urine Culture showed some infection. As kid is active and no traces of fever, doctor advised to repeat the Urine Culture as she has doubts of contamination while giving the sample. So we had to repeat the urine

culture 3 times and each time it showed three different organisms.

CUE: has everything normal (Nitrites - negative, pus cells - 3-5/HPF, ..) except specific gravity 1.025 (ref range: 1.016-1.022)

1st Urine culture: Organism - Pseudomonas aeruginosa. Count - 10^4 CFU/ml
2nd Urine culture: Organism - Klebsiella pneumoniae. Count - 10^5 CFU/ml
3rd Urine culture: Organism - Citrobacter koseri. Count - 10^5 CFU/ml

The doctor prescribed bacigyl and recommended USG Abdomen

we visited a different doctor and she said that urine culture reasons might be due to contamination. She said bacigyl would not work as all the oral anitbiotics were shown resistant. She said that may not be infection as there are no symptoms

except urine smell. She asked to watch the baby, if there is a fever then visit again.

I was wondering what to do and I fear if there is indeed infection it might affect kidneys. Should we go ahead and do a scan of Abdomen ?

Symptoms:  Only pungent urine smell. baby is active and no fever
Images: 
Pungent urine smell since c...-1 Pungent urine smell since c...-2 Pungent urine smell since c...-3
Doctor

A:   Thank you for your questions and scanned results.

When children are unable to speak and verbalize their symtoms, it can be a very worrisome time for parents. Fortunatley, sick kids are almost always sick. They do not play, they do not eat, they restirct fluid intake and generally speaking they do not thrive (stagnation or regression in growth or height).

The most important clue you have provided is that your child is actively playing and engaging with his or her environment. This is a very reassuring sign. having said that, should things change such as development of fever, restriction of oral intake or decrease in activity levels, your child should be reacessed.

I understand your confusion as you have seen 2 doctors with 2 differing opinions. I would have to agree with both approaches. Both approaches are reasonable given the circumstances.

The different organisms in 3 different cultures do suggest contamination. However, the fear is that an infection can lead to kidney damage and an ultrasound is very non invasive and non painful to the child.

Even though your child's behavior is reassuring, for the purposes of thoroughness and further reassurance, i would no hesitate doing the ultrasound as it is a risk free procedure.

i hope this was helpful

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