Urinary Tract Infections in Children
Content
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 body’s 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 body’s 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 UTI’s
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
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 body’s 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 body’s 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 UTI’s
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
