URINARY TRACT

INFECTIONS IN CHILDREN

Paediatric
Rotation

Peer-to-peer presentation by Student

Dr. Paul. M

What is a urinary tract infection (UTI)?

A UTI is an infection in the urinary tract. Infections are

caused by microbes (organisms too small to be seen without
a microscope) including fungi, viruses, and bacteria.

Bacteria are the most common cause of UTIs. Normally,

bacteria that enter the urinary tract are quickly removed by
the body before they cause symptoms. However, sometimes
bacteria overcome the bodys natural defences and cause
infection.

Infection can affect the urethra (urethritis), bladder (cystitis)

and bacteria may travel up the ureters to multiply and infect
the kidneys (pyelonephritis.)

What is the urinary tract?

The urinary tract is the bodys drainage system

for removing wastes and extra water. The urinary
tract includes two kidneys, two ureters, a
bladder, and a urethra.

What causes UTIs?

Most UTIs are caused by bacteria that live in the

bowel. The bacterium E. coli causes the vast majority
of UTIs.

Regular urination helps keep the urinary tract sterile

by flushing away bacteria, thus children who often
delay urination are more likely to develop UTIs
because holding in urine allows bacteria to grow.

Chronic constipation (if a child has fewer than two

bowel movements a week) can add to the risk of
developing a UTI because when the bowel is full of
hard stool, it presses against the bladder and bladder
neck, blocking the flow of urine and allowing bacteria

How common are UTIs in

children?

UTIs are common in kids. By the time they are 5

years old, about 8% of girls and about 1-2% of
boys have had at least one.

Boys who are younger than 6 months old who are

not circumcised are at greater risk for a UTI than
circumcised boys of the same age.

UTIs - Males vs. Females?

Females are more prone to urinary tract infections,

because the tube running from the bladder to the urethra
is much shorter than in men. Bacteria from stool can
easily contaminate the female urethra because the
urethral opening is relatively close to the anus in women

In males, a bladder infection is almost always a symptom

of an underlying disorder. Often, the infection has
migrated from the prostate or some other part of the
body, signaling problems in those locations. Or it may
indicate that a tumor or other obstruction is interfering
with the urinary tract.

What are the signs and symptoms of a

UTI?

In older kids, UTIs may cause obvious symptoms such

as burning or pain with urination. In infants and young
children, UTIs may be harder to detect because
symptoms are less specific. Fever is sometimes the
only sign.

Children may have a high fever, be irritable, or not

eat.

On the other hand, children may have only a lowgrade fever; experience nausea, vomiting, and
diarrhoea.

The urine may look cloudy or bloody. If a kidney is

How are UTIs diagnosed?

Urine Analysis: If a bag specimen reveals the following,

a urine specimen must be collected aseptically for
culture and sensitivity (which tests the bacteria for
sensitivity to different antibiotics to see which
medication is best for treating the infection ):
-positive leukocytes or nitrites on dipsticks
-Motile bacilli and increased leukocytes or
leukocyte casts on urine microscopy

How are UTIs diagnosed?

Aseptic urine collection:

-By suprapubic aspiration or transurethral bladder

catheterisation in
acutely ill children < 2 years or in smaller children who
are unable to
co-operate.
-By mid-stream clean catch method in older children

How are UTIs diagnosed?

Culture and Sensitivity criteria for the diagnosis of UTI

*any culture from a suprapubic urine sample

*a culture of > 104 col/mL urine of a single organism from
a catheter specimen
*a pure culture of > 105 col/mL in a mid-stream clean
catch sample or consistent culture of a pure growth
even with counts as low as 104 col/mL.

How are UTIs treated?

(Drug)

Most UTIs are caused by bacteria. Depending on

the expected culture and sensitivity of the
organism, treatment can be with antibiotics such as
amoxicillin/clavulanic acid iv 25mg/kg/dose tds x
7/7. If there is evidence of good clinical response,
change to amoxicillin/clavulanic acid po
30mg/kg/dose tds x 7/7

If needed, the health care provider may

recommend an appropriate over-the-counter
medication to relieve the pain of a UTI if the patient
goes home on oral antibiotics.

How are UTIs treated? (NonDrug)

Exclude complications of UTIs

Ensure adequate nutrition and hydration, to be

maintained orally or with iv fluids if necessary

For recurrent infections:

-Prevent constipation
-Treat pinworm
-Perineal hygiene
-Avoid irritant soaps/bubble baths

How can UTIs be prevented in children?

If a child has a normal urinary tract, parents can help

the child avoid UTIs by encouraging regular urination

The parents should make sure the child gets enough

to drink if infrequent urination is a problem.

The child should be taught proper cleaning

techniques after using the bathroom to keep bacteria
from entering the urinary tract. (i.e. Male vs. female
urinary tract anatomy)

Loose-fitting clothes and cotton underwear allow air to

dry the area.

Parents should consult a health care provider about

the best ways to treat constipation.

References

http://kidshealth.org/parent/infections/common/ur
inary.html

http://www.medicinenet.com/urinary_tract_infectio
ns_in_children/article.htm

http://www.aafp.org/afp/1998/0515/p2440.html

http://www.webmd.com/a-to-z-guides/understanding
-urinary-tract-infections-basics

http://www.auanet.org/content/education-and-mee
tings/med-stu-curriculum/pdf/adult-UTI.pdf