Urinary tract infections in children

Urinary tract infections (UTIs) are common in children. Symptoms and signs may be non-specific, particularly in neonates and infants. Older children may have dysuria, urgency, or frequency with a lower urinary tract infection, or fever, loin or back pain, and vomiting with pyelonephritis.

An appropriately obtained urine specimen can confirm the diagnosis and pathogen; urine culture and antimicrobial susceptibility testing will define the appropriate antibiotic for treatment.

Anatomical and functional abnormalities of the urinary tract and bowel may predispose children to recurrent UTIs. Further evaluation of children with recurrent UTIs is required to identify any treatable underlying cause. Recurrent UTIs may lead to renal scarring and renal insufficiency.

Paediatric urinary tract infection (UTI) is an illness caused by infection of the lower urinary tract (cystitis), the upper urinary tract (pyelonephritis), or both. The presence of pyuria and symptoms distinguishes UTI from asymptomatic bacteriuria.[1]American Academy of Pediatrics. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610. http://pediatrics.aappublications.org/content/128/3/595.long http://www.ncbi.nlm.nih.gov/pubmed/21873693?tool=bestpractice.com

Asymptomatic bacteriuria is the presence of bacteria in urine obtained in asymptomatic children on routine screening or incidentally during other investigations. The prevalence of asymptomatic bacteriuria is 0.37% in boys and 0.47% in girls, with highest rates in uncircumcised boys younger than 1 year old and girls older than 2 years of age.[2]Shaikh N, Osio VA, Wessel CB, et al. Prevalence of asymptomatic bacteriuria in children: a meta-analysis. J Pediatr. 2020 Feb;217:110-7. http://www.ncbi.nlm.nih.gov/pubmed/31787323?tool=bestpractice.com  Asymptomatic bacteriuria does not require treatment.[3]Fitzgerald A, Mori R, Lakhanpaul M. Interventions for covert bacteriuria in children. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD006943. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006943.pub2/full http://www.ncbi.nlm.nih.gov/pubmed/22336827?tool=bestpractice.com

Uncomplicated UTI: UTI in a patient older than 2 months, who has a structurally and functionally normal urinary tract, normal renal function, and a competent immune system.[4]European Association of Urology. Guidelines on paediatric urology. 2021 [internet publication]. https://uroweb.org/guideline/paediatric-urology  

Complicated UTI: UTI in a child who: is ≤2 months old; or has an structural or functional abnormality of the urinary tract; or has abnormal renal function; or is systemically unwell (toxic-looking, haemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication).[4]European Association of Urology. Guidelines on paediatric urology. 2021 [internet publication]. https://uroweb.org/guideline/paediatric-urology [5]National Institute for Health and Care Excellence. Urinary tract infection in under 16s: diagnosis and management. October 2018 [internet publication]. https://www.nice.org.uk/guidance/cg54 [6]Leung AKC, Wong AHC, Leung AAM, et al. Urinary tract infection in children. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):2-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751349 http://www.ncbi.nlm.nih.gov/pubmed/30592257?tool=bestpractice.com