URINARY TRACT INFECTIONS IN CHILDREN

Urinary tract infection is commonly caused by the following bacterial organisms: Eschericchia coli (75%), Klebsiella, Proteus vulgaris; less commonly by Streptococcus faecalis and some Pseudomonas species; and rarely by a Staphylococcus species.

Clinical Features

  • In children it is not easy to differentiate upper from lower urinary tract infections, but loin (lumbar) pain and tenderness suggest upper urinary tract infection.
  • In neonates and early infancy, boys are affected more often than girls because of the occurrence of the higher incidence of congenital urinary tract malformation in boys than girls that is noted at that age. Affected children present with fever, failure to thrive, irritability, poor feeding, and vomiting.
  • In older infants and children, girls are affected more often than boys because of their anatomically shorter urethra than that found in boys. Affected children present with anorexia, vomiting, fever, abdominal pain, frequency, enuresis in
    a previously dry child, and dysuria. For the younger child, the mother may report that the child cries when passing urine.
  • For all male children, ask about the nature of the stream of urine when they are passing it. In those with urinary tract obstruction, the urinary stream is poor.
  • Recurrences of urinary tract infection are common.

Investigations

The following investigations are recommended for a child with urinary tract infection:

  • Full blood count
  • Urinalysis: >10 WBC/cubic3 in uncentrifuged urine midstream or catheter specimen
  • Urine C&S (midstream, suprapubic puncture or catheter specimen). Bacterial colony count: Most reliable providing urine has been plated within 1 hour of voiding. Interpret results as follows:
    • <10,000: Nonspecific contaminants; significant if suprapubic specimen.
    • 10,000–100,000: Doubtful significance. Repeat cultures and evaluate clinical symptoms.
    • 100,000: Diagnostic of UTI.
  • The urine specimen should reach the laboratory within 2 hours of voiding or be refrigerated at 40C for a period not exceeding 24 hours.
  • Further evaluation include:
    Micturating cystourethrogram – urethral valves and reflux.
  • Abdominal ultrasound best done when child is febrile to demonstrate acute
    pyelonephritis.
  • Intravenous urography.
    • When associated with haematuria or proteinuria, pyuria is suggestive of parenchymal renal disease such as glomerulonephritis or interstitial nephritis.
  • Sterile pyuria is often due to TB – do cultures for TB.

Management

  • Encourage a lot of oral fluid.
  • Give amoxicillin OR cotrimoxazole for 7–14 days; nitrofurantoin can also be used.
  • Important: Clear infection in order to prevent chronic pyelonephritis.
  • Repeat urine culture 1 week after treatment.
  • Put children with recurrences of reflux on prophylaxis.
  • Refer to specialist if:
    • Patient is an infant.
    • Recurrent attacks occur more than 3 in one year.