Highlights for Management of a Child with a Urinary Tract Infection

Abstract

Urinary tract infections remain the most common bacterial infection in childhood. Escherichia coli is responsible for over 80% of Pediatric UTIs. Other common gram negative organisms include Kleibsiella, Proteus, Enterobacter and occasionally Pseudomonas. Signs and symptoms vary greatly by age of the patient becoming more specific as the child grows older. Even in the absence of specific signs a UTI should be included in the differential diagnosis of high grade fever. In younger children, presence of upper respiratory infections, otitis media or gastroenteritis does not eliminate the possibility of a UTI. Culture of the urine remains the gold standard for diagnosing UTIs. All males and females with well documented UTIs should be imaged for the presence of urological anomalies associated with UTI. Depending on patient's clinical symptoms and tolerance, therapy can be oral or parenteral as they have both been found equally efficacious. Healthcare professionals should ensure that when a child or young person has been identified as having a suspected UTI, they and their parents are given information about the need for treatment, the importance of completing any course of treatment and advice about prevention and possible long-term management.

Etiological Agents and Antimicrobial Susceptibility in Hospitalized Children with Acute Pyelonephritis

“…1,2,4 Other common gram negative organisms include Klebsiella, Proteus, Enterobacter, and occasionally Pseudomonas. Fungal infections are much less common and are usually to those who are immunecompromised or diabetic, are on long-term antibiotics, or have long-term indwelling catheter.…”

“…[2][3][4] Antibiotic resistance and multi-drug resistant infection, driven by antibiotic use, remain a major public health and professional concern.…”

Analysis of causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: A hospital based study

“…Proteus species was isolated in 43 (10.1%) samples and of the Proteus species 38 (88.4%) were identified in males. Previous studies have shown that Proteus species causes more UTIs in males [14][15][16] . In one study from Turkey Proteus species were isolated only in male patients 14 .…”

Bacterial Etiologies and Antibiotic Susceptibility Pattern of Urinary Tract Infections at the Pediatric Ward of Dastgheib Hospital, Shiraz, Iran: A Three-Year Study (2009 - 2011)

“…The incidence of UTI is greater in girls as compared to boys, which may be either due to anatomical structure or physiologic mechanisms (6,7). In boys, UTIs are much more common in uncircumcised boys especially during the first year of their life (8). Enteric Gram-negative bacteria are the most common cause of urinary tract infections, with Escherichia coli being the predominant pathogen (5,6).…”

“…Gram-positive bacteria, including Staphylococcus spp and Streptococcus spp (e.g. S. saprophyticus, Enterococci) have also been reported as pathogens in children with UTI (8)(9)(10). Delay in diagnosis and appropriate treatment is the cause of complication in the upper genitourinary system (5).…”