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UTI in children-management

UTIs are one of the most common bacterial infections of childhood In ambulatory care about 6 % of all acutely ill children have UTI’s Data has shown that about 8 % of all girls and 2 % of all boys will have atleast one episode by 7 yrs of age and about 12 % to 30 % of those will experience a recurrence Short female urethra and male circumcision account for marked female preponderance beyond infancy Bimodal peaks are seen with the first one in infancy and other peak from 2-4 yrs

 

Most common causes for UTI are bacteria
○ viruses , fungi and parasites can occasionally also be responsible
○ Adenoviruses can be associated with haemorrhagic cystitis
○ Candida can cause UTIs in immunocompromised children Escherichia coli ( E.coli ) is the most common uropathogen accounting for about 80 % to 90 % of paediatric UTI’s Other members of the Enterobacteriaceae family – Klebsiella , Proteus , Citrobacter , Serratia and Enterobacter can also be responsible Pathogenesis of UTI is complex -several host and pathogen factors influence the course of the illness and its outcome E Coli- Special properties as fimbriae which attach to the uroepithelial cell surface allows them to overcome host defenses

 

Lower  UTI infection of bladder (cystitis ) or urethra – bacteriuria with no systemic features localised symptoms as lower abdominal or suprapubic pain , dysuria , urinary frequency and urgency

 

Upper UTI -infection and inflammation of the kidneys ( pyelonephritis ) and ureters accompanied by systemic features such as anorexia , vomiting , lethargy and malaise children with bacteriuria and fever ≥ 38 deg or temp < 38 but with loin pain / tenderness should be considered to have acute pyelonephritis / upper UTI.

 

In younger patients differentiating between upper and lower UTI is not always possible as typical symptoms are often absent.

 

Infants with a high risk of serious illness – refer PAU Infants < 3 months with possible UTI-refer PAU
 Infants and children 3 months or older with acute pyelonephritis / upper UTI 
○ consider referral to a paediatric specialist
○ treat with antibiotic as per NICE guidance
 3 months or older with cystitis / lower UTI-treat as per NICE guidance.

 

< 6 months of age Non-E Coli UTI Recurrent UTI’s Children with an abnormality on imaging ( for e.g US ) Any concerns with BP , height , weight , proteinuria if in doubt- email / tel for adv

REFERENCES

  1. *NG109 Lower urinary tract infection visual summary (nice.org.uk)
  2. Recommendations | Urinary tract infection in under 16s: diagnosis and management | Guidance | NICE
  3. Pyelonephritis ( acute ) antimicrobial prescribing *visual-summary-pdf-6544161037 (nice.org.uk)
  4. CKS UTI in children Scenario: UTI in children | Management | Urinary tract infection – children | CKS | NICE
  5. Alex Emergency Department – Paediatric Clinical Practice Guideline BSUH Paediatric Guidelines
  6. Nottinghamshire Area Prescribing Committee 20-uti-in-children-kr.pdf (nottsapc.nhs.uk)
  7. UTI in children by Hasiao-Wen Chen Urinary Tract Infection in Children | IntechOpen
  8. Kaufman, Jonathan et al. “Urinary tract infections in children: an overview of diagnosis and management.” BMJ paediatrics open vol. 3,1 e000487. 24 Sep. 2019, doi:10.1136/bmjpo-2019-000487 Urinary tract infections in children: an overview of diagnosis and management (nih.gov)

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