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urinary tract infection (UTI) in children

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  • a urinary tract infection is an important diagnosis in a child not to miss because infection may damage the developing kidney
  • as with adults, a urinary tract infection in children is defined as more than 10 to the power 5 organisms per ml in voided urine (studies on urine specimens from large numbers of hospital patients confirm that a pure growth of 10^5 organisms per ml or greater is indicative of infection (1)
  • about 2% of boys and 8% or more of girls will develop a urinary tract infection during childhood

Note that in some children, especially boys, the child may not retain urine in the bladder for a long enough period for multiplication to a pure growth of 10^5 organisms per ml to occur. In these cases a pure growth of 10^4-10^5 organisms may indicate infection.

NICE note that clinical features suggestive of UTI, in a child less than 5 years, are:

  • vomiting
  • poor feeding
  • lethargy
  • irritability
  • abdominal pain or tenderness
  • urinary frequency or dysuria
  • offensive urine or haematuria

NICE now state if suspected UTI is an infants younger than 3 months then:

  • there are concerns about sepsis in infants under 3 months with suspected UTI, and usual practice is referral rather than the GP managing symptoms. So the committee recommended that all children under 3 months should be referred to specialist paediatric care and have a urine sample sent for urgent microscopy and culture

Notes:

  • infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested within 24 hours

  • infants and children with an alternative site of infection should not have a urine sample tested. When infants and children with an alternative site of infection remain unwell, urine testing should be considered after 24 hours at the latest

Reference:

  1. NICE (September 2017). Feverish illness in children Assessment and initial management in children younger than 5 years
  2. Prescriber 2000;11 (18): 21-37.
  3. Jantauch, B.A.t al.. Association of Lewis blood group with urinary tract infection in children. J. Pediatrics 1994;124:863-868
  4. Drug and Therapeutics Bulletin, 35, 65-9.

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