Urinary Tract Infection (UTI) in Children

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  • Post last modified:October 20, 2021

Introduction

A urinary traction infection (UTI) is an infection of the urinary system. It refers to the invasion of urinary tract by pathogenic organisms. It can involve any part of the urinary system, including the urethra, ureters, bladder and kidneys. Symptoms typically include urinary frequency , painful urination and abdominal and flank pains.
Urinary tract infection is a potential cause of renal scarring, calculi, hypertension, chronic renal failure.
It can be associated with various anomalies and voiding dysfunction.
Urinary tract obstruction is a risk factor.
UTI include cystitis, pyelonephritis and asymptomatic bacteriuria.
Breast feeding has been associated with
reduced risk of UTI in child less than 6months.

Incidence of UTI in Children

Incidence varies according to the age and
sex:

  • 1-3 % of girls.
  • At age of less than 1 year, incidence in males is greater than that of female with a ratio of 2.8-5.4 : 1 and
  • At age 1-2 years, incidence in females is greater than that of males at a ratio of 10 : 1.
  • Neonates: 1-4%; M>F (preterms 2.9%, full term 0.7%)
  • Infants (1 month-1 year): 1.1-1.2 &(2%) M=F
  • > 7yrs: 2.5% F>M

Clinical features:

Neonates:

  • Non-specific
  • Vomiting, irritability, diarrhea, poor feeding, failure to thrive, dehydration

Infants and toddlers

  • fever may or may not be present

Older children:

  • Frequency, urgency, dysuria, abdominal pain, enuresis, flank pain, hematuria

Investigations

  • Urinalysis and MCS:
    • Best specimen for this is the supra-pubic aspirate
    • Mid Stream Urine can also be used
    • Clean voided bag specimen

In 2months – 2yrs

  • WBC > 5HPF
  • Proteus produces alkaline pH
  • microscopic hematuria

Urine MCS:

  • any colony count following
    a Supra Pubic Aspirate is diagnostic

    • 100,000 cfil/ml – female
    • 10,000 cfil/ml male.

Others:

  • Renal ultrasound
  • DMSA( dimecaptosuccinic acid) parenchymal filling defect in acute pyelonephritis
  • It is superior to RUSS and IVU
  • MCUG: may be indicated in suspected anatomic anomaly e.g. reflux, PUV.
  • IVU: – produces information regarding precise anatomic image
    •  estimate renal function not reliable for detecting renal scarring or pyelonephritis
    • large dose radiation is required
  • Renal cortical scintigraphy

Complications

Immediate

  • Bacteremia
  • Dehydration

Late

  • Chronic urinary tract infection,
  • Renal scarring
  • Hypertension

Treatment

Goal:

  • To eradicate the causative organism and correct associated symptoms

Specific treatment

Antibiotics therapy for 10-14days
Cotrimoxazole 

  • Child < 2 years: contraindicated
  • Child> 2 years:
    • 8 mg TMP/kg/day orally every 12 hours for 7-14 days
  • Serious infection
    • 8-10 mg TMP/kg/day IV every 6-12 hours  for 14 days
  • Prophylaxis:
    • 2 mg TMP/kg/dose PO daily or 5 mg TMP/kg/dose twice weekly

Ceftriaxone:

  • Child < 45 kg: 50 mg/kg/day IM/IV in single daily dose for 7 days; daily dose not to exceed 1 g
  • Child > 45 kg: 50 mg/kg/day IM/IV in single daily dose for 7 days

Cefixime 

  • <6 months: Safety and efficacy not established
  • 6 months-12 years:
    • ≤45 kg: 8 mg/kg/day orally in a single daily dose or divided 12 hourly
  • >12 years, >45 kg: 400 mg/day orally in a single daily dose or divided 12 hourly.

Amoxicillin Clavulanic acid (Dosages based on amoxicillin)

  • Child <40 kg
    • <3 months old: 
    • 30 mg/kg/day orally (125 mg/5 mL) divided 12 hourly
    • >3 months old

Less severe infections:

    • 20 mg/kg/day orally divided 8 hourly or 25 mg/kg/day orally divided 12 hourly

Supportive treatment

  • Hydration
  • Feeding
  • Perineal education

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