Optimising paediatric urinary tract infection diagnosis

Abstract

Urinary tract infection (UTI) is the most common cause of serious bacterial illness among children and infants.1 Up to 2% of boys and 8% of girls will develop at least 1 episode of UTI by the age of 7 years.1,2 Of these, it is estimated that 12% to 30% will experience recurrence within a year.3 While majority of patients recover without any long-term sequelae, UTIs can lead to severe complications such as kidney scarring and sepsis if not diagnosed and treated promptly. A very small proportion of children will develop kidney failure from UTI, which is typically a result of recurrent UTIs. Known risk factors for UTI among children include female sex, age and the presence of conditions that affect urine flow, such as vesicoureteric reflux or urinary stasis (neurogenic bladder, constipation).4 UTI typically develops due to the ascension of uropathogens that colonise the periurethral regions to the bladder (cystitis), which may ascend further up the urinary tract (pyelonephritis) and lead to bloodstream infection (urosepsis). UTIs from haematogenous spread is possible, although uncommon. Common pathogens implicated are gram-negative bacteria—primarily Escherichia coli; however, other pathogens such as Klebsiella, Proteus and Enterobacter can also be involved.