Paediatrics: Urinary tract infection

2021-03-04 12:00 AM

Up to 3% of girls and 1% of boys suffer from UTI during childhood.

Urinary tract infection

Up to 3% of girls and 1% of boys suffer from UTI during childhood. A UTI may be defined in terms of the presence of symptoms (dysuria, frequency, loin pain) plus the detection of a significant culture of organisms in the urine:

  • Any growth in the culture of suprapubic aspirate.
  • >105Organisms/mL in pure growth from a carefully collected urine sample (midstream urine, clean-catch urine, or bag urine). Ideally 2 consecutive growths of the same organism with identical sensitivities, but this is not always practical.

Note: Bacteriuria in the absence of symptoms does not necessarily need treatment, but needs to be considered in the clinical context (e.g. previous UTI, predisposing urinary tract abnormalities).

Guidance on the investigation, treatment and management of UTIs have been published.1

Clinical features

Presentation varies; symptoms in infants may be non-specific:

  • vomiting/diarrhoea;
  • poor feeding/failure to thrive;
  • prolonged neonatal jaundice.

Examination

  • Height and weight: plot on the growth chart.
  • BP.
  • Examination for abdominal masses.
  • Examine the genitalia and spine for congenital abnormalities.
  • Examine lower limbs for evidence of neuropathic bladder.

Diagnosis

Try to distinguish between the upper (fever, vomiting, loin pain) vs. lower urinary tract symptoms (dysuria, frequency, mild abdominal pain, enuresis). Differentiation is often not possible in the younger child.

  • UTI is a major cause of sepsis in a young infant.
  • Ask about the urinary stream in boys and family history of vesicoureteric reflux (VUR) or other urinary tract abnormality.
  • Dipstick test in the urine. ‘Leucocytes’ and ‘nitrites’ strongly suggest UTI. Urine should be sent for microscopy, culture, and sensitivity.

Acute treatment

Antibiotics should be started after urine collection (see Table 11.2).