Urinary tract infection in Child
Alerts and Notices
Synopsis
Urinary tract infection (UTI) is a general term that describes infection anywhere in the urinary system. UTI can be further subclassified by the exact location of the infection, presence or absence of symptoms, and complications. In everyday practice, these classifications are subject to significant overlap and cause clinical confusion.
Definitions
- Bacteriuria – Presence of bacteria in the urine.
- Cystitis – Syndrome involving constellation of dysuria, frequency, urgency, and occasionally suprapubic tenderness; can be present in the setting of lower urinary tract inflammation in the absence of infection or urethritis.
- Acute pyelonephritis – Clinical syndrome characterized by flank pain, flank tenderness, and fever often associated with cystitis symptoms in the presence of significant bacteriuria. This triad of symptoms (flank pain, fever, and nausea / vomiting) can also be seen in noninfectious etiologies, including renal calculi and renal infarction.
- Uncomplicated UTI – UTI in a structurally and neurologically normal urinary tract.
- Complicated UTI – UTI in the presence of anatomical or functional abnormalities. In general, UTIs in men, pregnant individuals, children, and patients in a health care-associated setting may be considered complicated.
- Urosepsis – Sepsis caused by a UTI.
UTIs are a common infection in neonates and children, with an incidence of approximately 1%-2%. They occur more commonly in males during the first 3 months of life and otherwise are more common in females throughout infancy and childhood.
Symptoms
Just as in adults, UTIs present with a range of symptoms in children. Patients may present with fever, abdominal or back pain, nausea or emesis, dysuria, hematuria, and/or fatigue. Approximately 7% of undifferentiated febrile illnesses in neonates and young infants are due to UTIs.
Etiology
Bacteria are the leading cause of UTIs. Escherichia coli (80% of cases) and other gram-negative bacteria are the leading culprits. Gram-positive, viral, and fungal organisms are less likely to cause UTIs.
Risk Factors
- Age: male patients younger than 1 year and female patients older than 4 years
- Uncircumcised males younger than 1 year
- Northern European ethnicity
- First-degree relative with history of UTI
- Anatomic or functional abnormality and resultant vesicoureteral reflux: posterior urethral valves, ureteropelvic junction obstruction
- Neurogenic bladder: spinal cord injury (ie, myelomeningocele)
- Bladder or bowel dysfunction
- Sexual intercourse (increases UTI risk in females)
- Bladder catheterization
- Constipation
- Ascending route – In the majority of the UTIs, pathogens gain access to the urinary tract by ascending up the urethra to the bladder. Further ascent of pathogens is the cause of the majority of renal parenchymal infections. Urethral massage and sexual intercourse facilitate the first step of this process in females. Indwelling catheters facilitate ascent, and spermicides promote vaginal colonization with pathogens.
- Hematogenous route – Associated with abscess formation in the kidneys. Usually results from bacteremia with virulent pathogens such as Staphylococcus aureus, Salmonella, or possibly Candida. Infection of the kidney with gram-negative bacilli through a hematogenous route is rare in humans, although ascending pyelonephritis can lead to bacteremia in 20%-30% of cases.
Prompt treatment of UTI is paramount to minimize potential for pyelonephritis, renal abscesses, and renal scarring that can result in chronic renal injury. If an underlying behavior or anatomic condition is identified that places the patient at increased risk for recurring UTIs, treatment of the underlying disorder is strongly advised. Risk factors for renal scarring due to UTI include delay in effective treatment, recurrent febrile UTIs, anatomic variants causing obstruction, and bladder / bowel dysfunction.
Codes
ICD10CM:N39.0 – Urinary tract infection, site not specified
SNOMEDCT:
68566005 – Urinary tract infectious disease
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Fever in newborn – Bacteremia, meningitis, pneumonia, skin / soft tissue infection with or without abscess. See also neonatal bacterial sepsis.
- Renal abscess
- Pancreatitis (acute and chronic)
- Infectious gastroenteritis or colitis
- Inflammatory bowel disease (see Crohn disease, ulcerative colitis)
- Vaginitis (see also vulvovaginal candidiasis) – Presents with vaginal discharge and itching, both of which have negative likelihood ratios for UTI diagnosis.
- Urethritis – May present with a cystitis triad (dysuria, frequency, and urgency), but urine culture will be negative. Look for a negative nitrite test and absence of pyuria; there is often a urethral discharge.
- Pelvic inflammatory disease – Usually accompanied by deep-seated abdominal or pelvic pain, vaginal discharge, and fever.
- Nephrolithiasis
- Interstitial cystitis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/17/2019
Last Updated:08/08/2021
Last Updated:08/08/2021
Patient Information for Urinary tract infection in Child
Overview
A urinary tract infection (UTI) is the spread of bacteria anywhere in the urinary system. A UTI typically begins when bacteria enters the urethra and multiplies in the bladder, where urine collects. The UTI can be in the kidneys, bladder, ureter, or urethra, but they mostly occur in the lower urinary tract (urethra and bladder). Recurrent UTIs without complications are common in young, healthy women. However, anyone can get a UTI.Who’s At Risk
Some risk factors for UTIs include:- History of previous UTI
- Frequent sexual activity with difficulty urinating after intercourse
- Use of spermicidal agents or diaphragms as birth control
- After menopause, experiencing estrogen deficiency
- Blockage to the urinary tract such as a kidney stone
- Diseases that suppress your immune system or transplant surgery
- Diabetes mellitus or bladder prolapse
- Urinary procedures or urinary catheter use
A woman's shorter urethra is more susceptible to infection, but men get UTIs too.
Signs & Symptoms
UTIs do not always occur with symptoms, but when they do, a UTI can cause:- Burning or painful sensation when urinating
- Persistent urge to urinate
- Cloudy or pink urine
- Strong-smelling urine
- Pelvic pain for women
- Fever
Self-Care Guidelines
These guidelines should be followed when you have a UTI or want to avoid getting a UTI:- Drink lots of water to help clear bacteria from your urine
- Stay away from irritating beverages such as coffee, citrus juice, alcohol, and soft drinks
- After a bowel movement, be careful to wipe front to back so bacteria is not spread to the urethra and bladder
- Use a warm heating pad for short periods of time for bladder pain relief
- Nonprescription pain relief may be helpful (Tylenol, Motrin, Advil)
When to Seek Medical Care
Contact your health care provider when you have signs or symptoms of UTI, especially flank pain, back pain, fever, blood in the urine, painful urination, nausea and vomiting, and urinary urgency and frequency.Treatments
Your doctor may prescribe medication for your UTI:- A complete course of oral antibiotics for infection; in more severe cases, antibiotics may be administered by tube
- Prescription medication for bladder pain
Urinary tract infection in Child