Peer-to-peer presentation by Student Dr. Paul. M

Paediatric Rotation

URINARY TRACT INFECTIONS IN CHILDREN

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 to grow.

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 low-grade fever; experience nausea, vomiting, and diarrhoea.

The urine may look cloudy or bloody. If a kidney is infected, children may complain of pain in the back or side below the ribs.

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? (Non-Drug) 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/urinary.html

http://www.medicinenet.com/urinary_tract_infections_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-meetings/med-stu-curriculum/pdf/adult-UTI.pdf

Hospital Level Paediatrics EDL, page 110, chapter 6 (Genito-Urinary System)