Urinary Tract Infections, Pediatric

Basics

Description

  • Bacteria colonize via retrograde contamination of rectal or perineal flora:
    • Infants – often hematogenous spread
    • Older children – vesicoureteral reflux (VUR) major risk
  • UTI is defined by culture of a single organism of >50,000/mL on a catheterized or suprapubic specimen. Other collection techniques are not routinely used in young children for definitive diagnosis
  • By 6 yr of age, 2% of boys and 8% of girls have had a UTI
  • In infants 0–3 mo old, UTI is associated with a 30% incidence of sepsis
  • Predisposing factors:
    • Poor perineal hygiene
    • Short urethra of female
    • Female > male
    • Infrequent voiding
    • Constipation
    • Sexual activity
    • Male circumcision probably reduces risk
    • Vesicoureteral reflux (VUR)/obstruction to flow
    • Bladder dysfunction
    • Hypercalciuria

Etiology

  • UTI found in 4–7% of febrile infants
  • Bacterial agents:
    • Escherichia coli accounts for 80%
    • Klebsiella pneumoniae
    • Staphylococcus aureus
    • Enterobacter species
    • Proteus species
    • Pseudomonas aeruginosa
    • Enterococcus species

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