Urinary Tract Infection

Urinary tract infection (UTI) is the most common bacterial infection in children.

In new born infants it occurs two or three times more often in boys than girls but later girls may be more prone.

The genesis of UTI is not clearly established.  The commonest pathogen is E. Coli and it is assumed that the organism enters the urethra from the perineum as identical strains of E. Coli can be isolated from the child’s intestinal tract.

Unlike adults who usually present with burning pains on urination, passing blood in the urine or passing urine more frequently; the child may have neither symptoms nor signs.  

If signs are present they may be non-specific, such as prolonged jaundice in the newborn; loss of appetite, vomiting or fever in the infant; and non-specific abdominal pain, irritability, loss of appetite or fever in the toddler.

An appropriate antibiotic is the usual treatment for a proven UTI and long term antibiotic prophylaxis (prevention) has been the usual treatment for proven reflux.  This may be required for months or years, depending on the severity of the condition.

As in all childhood infections, there is now concern about such use of antibiotics.  Some paediatric nephrologists (kidney specialists) recommend that antibiotics only be used when a proven urinary tract infection is accompanied by fever as research indicates that fever in such circumstances is an indicator of potential kidney damage.

Any proven UTI must be further investigated to exclude significant ureteric reflux or other structural abnormality which allows urine to flow back up to the kidney from the bladder and cause infection.  There is an increased incidence of recurrent infection in children with ureteric reflux and they are thus susceptible to kidney damage.