Urinary tract infection in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rana aljebzi, M.D.[2]

Synonyms and Keywords: Urinary tract infection in kids

Overview

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

Urinary tract infection in children may be classified to:[1]


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UTI classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
level of the infection
 
 
 
 
 
 
 
 
Severity
 
 
 
 
 
 
 
 
Recurrency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cystitis:infection in the bladder
 
Pyelonephritis:infetion of the renal pelvis and kidney
 
Urethritis:infection of the urethra
 
Complicated
 
 
 
Uncomplicated
 
 
 
First time of infection
 
 
recurrent infection
 

Pathophysiology

The urinary tract in healthy children is usually sterile. The urethra on the other hand is colonized with bacteria. UTI occurs with the entrance of pathogens into the urinary tract and subsequent adherence to it. Although normal voiding with intermittent urinary outflow usually clears pathogens within the bladder. that is why the pathogenesis of UTI in Urinary malformation, urine stasis, impaired urine flow increased reservoir, and giving more time to establish infection and adherence of bacteria to the uroepithelial mucosa being the main predisposing factors for the development of UTI. Congenital obstructive uropathy, "detrusor sphincter" dyssynergia syndrome is an infrequent bladder emptying and stasis, which are also causes of UTI. The second mechanism is the introduction of pathogens by way of a foreign body or instrument. Urinary infection is the third most common nosocomial infection after primary bloodstream infections and pneumonia in intensive care units. A recent prospective study estimates the incidence of nosocomial UTI as 0.6 case/1000 patient/day and newborns and infants are affected disproportionately. The infection is associated frequently with urethral catheterization. Escherichia coli accounts for 80 to 90% of UTI in children. Among febrile infants, unwell children in general practice, and older children with urinary symptoms, 6%–8% will have a UTI, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcomes. The prevalence varies with age, peaking in young infants, toddlers, and older adolescents. UTI is more common in female and uncircumcised male infants. During toddler years, toilet training can lead to volitional holding and bladder stasis, promoting UTIs. Over 30% of children with UTI will have recurrent UTI. Common risk factors for recurrence include vesicoureteric reflux (VUR) and bladder–bowel dysfunction. Older non-continent children (eg, developmental delay) also have more recurrent UTIs.[2][3]

Causes

The common pathogenic sources of UTI are bacteria of enteric origin, although other pathogens (fungi, mycobacteria, and viruses) also are encountered. Escherichia coli is responsible for over 80% of all mechanisms of UTIs. pathogens in the urinary tract of a healthy child is usually the result of retrograde migration of enteric bacteria colonizing the periurethral area and reflects this flora. Other common gram-negative organisms include Klebsiella, Proteus, Enterobacter, and occasionally Pseudomonas. Proteus mirabilis is a common pathogen in males and in children with kidney stones. Gram-positive pathogens include group B Streptococcus and Enterococcus in neonates and infants reflecting the colonization status of the mothers, and Staphylococcus saprophyticus in adolescent girls. Fungal infections are much less common and are usually to those who are immune-compromised or diabetic, on long-term antibiotics or have a long-term indwelling catheter. Viral UTI is more common in immunocompromised patients, particularly those receiving immunosuppressants, than in otherwise healthy children. Adenovirus and BK virus are viral pathogens that may cause hemorrhagic cystitis Often urine is contaminated by Lactobacillus species, Corynebacterium spp., coagulase-negative staphylococci, and α hemolytic streptococci,and not considered pathogens in otherwise healthy children 2 months to 2 years of age.[4][5]

Differentiating [disease name] from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

  • The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
  • In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

  • Patients of all age groups may develop [disease name].
  • [Disease name] is more commonly observed among patients aged [age range] years old.
  • [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

  • [Disease name] affects men and women equally.
  • [Gender 1] are more commonly affected with [disease name] than [gender 2].
  • The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

  • There is no racial predilection for [disease name].
  • [Disease name] usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop [disease name].

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • [Disease name] is usually asymptomatic.
  • Symptoms of [disease name] may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with [disease name] usually appear [general appearance].
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

  • There are no specific laboratory findings associated with [disease name].
  • A [positive/negative] [test name] is diagnostic of [disease name].
  • An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
  • Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

  • [Disease name] may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

  • There is no treatment for [disease name]; the mainstay of therapy is supportive care.
  • The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action 1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

  • Surgery is the mainstay of therapy for [disease name].
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
  • [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

  • There are no primary preventive measures available for [disease name].
  • Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

  1. Chang, Steven L.; Shortliffe, Linda D. (2006). "Pediatric Urinary Tract Infections". Pediatric Clinics of North America. 53 (3): 379–400. doi:10.1016/j.pcl.2006.02.011. ISSN 0031-3955.
  2. Habib S (2012). "Highlights for management of a child with a urinary tract infection". Int J Pediatr. 2012: 943653. doi:10.1155/2012/943653. PMC 3408663. PMID 22888360.
  3. Kaufman J, Temple-Smith M, Sanci L (2019). "Urinary tract infections in children: an overview of diagnosis and management". BMJ Paediatr Open. 3 (1): e000487. doi:10.1136/bmjpo-2019-000487. PMC 6782125 Check |pmc= value (help). PMID 31646191.
  4. Ma, Jian F; Shortliffe, Linda M.Dairiki (2004). "Urinary tract infection in children: etiology and epidemiology". Urologic Clinics of North America. 31 (3): 517–526. doi:10.1016/j.ucl.2004.04.016. ISSN 0094-0143.
  5. Sobel, J. D.; Vazquez, J. A. (1999). "Fungal infections of the urinary tract". World Journal of Urology. 17 (6): 410–414. doi:10.1007/s003450050167. ISSN 0724-4983.

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