Urinary tract infection (UTI) is an infection that occurs when bacteria gain access into the urinary system, i.e. the bladder and the kidneys. UTI is one of the most common bacterial infections in children and requires prompt recognition, treatment and investigations.
Symptoms of urinary tract infection are usually non-specific in a baby or young child. Unexplained fever or fever without an obvious source is the only consistent symptom among young children with UTI.
In some infants : There may be poor feeding, increased irritability, vomiting or cloudy and smelly urine.
In older children : The symptoms are more specific to the urinary tract. They may have pain or a burning sensation when passing urine, increased frequency of urination, an urge to urinate even after emptying their bladders, lower abdominal pain and uncontrolled wetting.
Pain over the loin and fever suggests a more serious infection in older children.
Urinary tract infection is usually caused by bacteria commonly found in the stools, which can stay on the skin around the buttock areas. The bacteria can gain access into the urethra which is the passage leading to the bladder from outside the body and along which urine passes. Why UTI occurs in a child is not fully understood but it is not entirely due to poor cleaning or inadequate changing of diapers. In some children, an underlying abnormality of the urinary tract can predispose them to UTI.
Urinary tract infection is diagnosed by testing the urine for the presence of pus cells and bacteria. A fresh urine sample should be collected, avoiding contamination as far as possible. Collecting the midstream of the urine as the child urinates after cleaning his/her private area well does this. If this cannot be done especially in young infants, it may be necessary to collect urine by passing a fine tube into the bladder through the urethra or to collect the urine through a small needle that is inserted into the bladder through the abdomen. These procedures are safe in the hands of experienced doctors.
Using adhesive bags to collect urine specimens are not reliable as they are often contaminated. Urine specimens once collected are usually tested with a dipstick to look for pus cells and when present, it may indicate the presence of UTI. A definitive diagnosis of UTI can only be made by sending the urine to the laboratory to see whether there is any significant growth of bacteria in the urine. This process is termed urine culture and it takes 48 – 72 hours to be ready.
Antibiotics to kill the bacteria are used in the treatment of UTI. Oral antibiotics are used for older children who are otherwise fairly well. Children especially young babies, who are unwell, are often admitted to hospital for more aggressive and effective antibiotic treatment by injecting the antibiotics directly into the blood stream through a drip or what is termed intravenous antibiotic treatment.
Intravenous antibiotic is converted to oral antibiotic when the fever has settled for 24 hours and when the child’s condition has improved. The choice of antibiotics is based on the urine culture result, which will show the most appropriate antibiotic to be used.
The whole course of treatment for UTI usually lasts 14 days. After which a low nightly dose of antibiotics (prophylactic or preventive antibiotics) may be continued in young babies, till further review by doctors.
Children with UTI will require regular reviews with the doctor after discharge. Imaging studies of the urinary tract are also necessary to assess if there are any underlying abnormalities. Such studies include: ultrasound of the kidneys and the urinary tract, a kidney scan called DMSA scan, and a special radiological study called Micturating Cystourethrogram (MCU).
Parents need to remember that their child must complete the full course of antibiotics after discharge. Some children may need to continue treatment with a small nightly dose of antibiotic to prevent recurrent UTI while waiting to have further tests done. This small dose of antibiotic is safe and will have no long-term adverse effect on the child’s health.
There is a possibility that the child might get another UTI even if the child is on a small dose of preventive antibiotic. If the child develops any symptoms suggestive of a UTI as mentioned earlier or is unwell with a fever with no other obvious cause, please bring the child to the doctor for a urine test as soon as possible.
Good hygiene practices, avoiding constipation, going to toilet regularly to empty the bladder and adequate fluid intake are some measures that may help deter UTI.
Most children make very good recovery after UTI and have no further problems. In a small group of patients, scars may form in the kidneys, which can give rise to high blood pressure, and require long term monitoring and follow-up.
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