urinary%20tract%20infection%20(pediatric)
URINARY TRACT INFECTION (PEDIATRIC)
Nonspecific urinary tract infection symptoms in infants <3 months are fever, feeding difficulties, vomiting, lethargy, irritability and failure to thrive.
Toddlers and preschoolers have unusual odor of urine, abdominal or flank pain, frequency, dysuria, and urgency.
School-age children have the classical symptoms of fever, frequency, urgency and dysuria.
Consider UTI in all seriously ill children even when there is evidence of infection outside the urinary tract.

Etiology

Probable Pathogen 

  • E coli is the causative agent of the majority of urinary tract infection (UTI)
  • Klebsiella spp, Citrobacter spp, Enterococcus spp, Pseudomonas aeruginosa, Staphylococcus saprophyticus, S aureus, Proteus sp

Probable Non-pathogen

  • Coagulase-negative staphylococci, Viridans sterptococci
  • Diphtheroids, lactobacilli

C-reactive Protein

  • May help differentiate upper urinary tract infection (UTI) from lower urinary tract infection (UTI) & other causes of bacteriuria
  • A concentration of >20 ug/mL signifies a serious bacterial infection; may be useful in ruling out acute pyelonephritis/upper urinary tract infection (UTI) in patients w/ pyuria & fever who may have viral infection

Risk Factors

  • Temperature ≥39°C
  • Uncircumcised boys <1 year old
  • Sexual activity among young girls
  • Fecal & perineal colonization
  • Urinary tract malformation, functional urinary abnormalities [eg vesicoureteral reflux (VUR), neurogenic bladder], enlarged bladder
  • History of urinary tract infection (UTI), dysfunctional voiding
  • Presence of a spinal lesion, abdominal mass
  • High blood pressure (BP)
  • Fever of uncertain origin

Signs and Symptoms

Signs & Symptoms Consistent w/ Urinary Tract Infection (UTI) Based on Patient’s Age

Infants <3 Months

  • Nonspecific: Fever, feeding difficulties, vomiting, lethargy, irritability, failure to thrive
  • Less common: Abdominal pain, jaundice, hematuria, strong-smelling urine, sepsis syndrome, shock

Toddlers & Preschoolers

  • Unusual odor of urine
  • Abdominal or flank pain
  • Frequency, dysuria, urgency
  • Nonspecific signs may be present

School Age

  • Classical symptoms more common: Fever, frequency, urgency, dysuria
  • Strong-smelling urine, new onset urinary incontinence, changed behavior
  • Abdominal or flank pain

Consider urinary tract infection (UTI) in all seriously ill children even when there is evidence of infection outside the urinary tract

Signs & Symptoms Consistent w/ Urinary Tract Infection (UTI) Based on Severity

Simple Urinary Tract Infection (UTI)

  • Mild pyrexia, good fluid intake, mild dehydration, good treatment compliance

Severe Urinary Tract Infection (UTI)

  • Fever ≥39°C, persistent vomiting, severe dehydration, poor treatment compliance
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