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| '''Urinary tract''' infections ('''UTIs''') are common in kids. it occurs when bacteria (germs) get into the bladder or kidneys.Up to 8% of girls and 2% of boys will get a UTI by age 5.
| | <nowiki>*</nowiki>/Most small children with febrile UTI do not develop renal damage and if they do the majority remain unchanged or regress over time.PMID: 28681079 |
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| Sometimes the symptoms of this infection can be hard to spot in kids,that is why Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition.PMID: 30592257
| | <nowiki>*</nowiki>/Differentiating UTI from asymptomatic bacteriuria, which usually requires no treatment, can lower the frequency of unnecessary antibiotic prescriptions.PMID: 20539810 |
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| | <nowiki>*</nowiki>/Febrile infants with UTIs should undergo renal and bladder ultrasonography. PMID: 26361319 |
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| A baby with a '''UTI''' may have a fever, throw up, or be fussy. Older kids may have a fever, have pain when peeing, need to pee a lot, or have lower belly pain
| | Some factors make it easier for bacteria to enter or stay in the urinary tract, such as: |
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| | *Vesicoureteral reflux in which urine flow backs up into the ureters and kidneys. |
| | *Brain or nervous system illnesses (such as myelomeningocele or spinal cord injury). |
| | *Bubble baths or tight-fitting clothes (girls). |
| | *Changes or birth defects in the structure of the urinary tract. |
| | *Not urinating often enough during the day. |
| | *Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out.https://medlineplus.gov/ency/article/000505.htm<nowiki/>* |
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| | <nowiki>*</nowiki>/UTIs are more common in girls. This may occur as children begin toilet training around 3 years of age. Boys who are not circumcised have a slightly higher risk of UTIs before age 1. |
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| causesPMID: 20514772
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| | 10.1016/j.pcl.2006.02.011. [[International Standard Serial Number|ISSN]] 0031-3955 |
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| 10.1586/14787210.2015.986097 dio
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| * fire: UTI in children is of concern because it can be associated with acute mortality (i.e. urosepsis) and/or chronic medical problems like renal scarring, hypertension, and chronic renal insufficiency [7].PMID: 25421102
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| <br />In the age of “ALARA” (as low as reasonably achievable), physicians must judiciously utilize imaging to decrease the adverse events associated with radiation exposure. In 1999, the AAP recommendations for imaging after an initial febrile UTI were extensive and included renal and bladder ultrasound, voiding cystourethrography (VCUG) or radionuclide cystography in all children younger than two years of age [43]. This approach became widely known as the “bottom-up” algorithm because it begins with the diagnosis of VUR. In these guidelines, the AAP was vague concerning the use of 99mTc-DMSA. However, the American Academy of Family Physicians advised this test after treatment of UTI to determine if permanent renal scarring occurred. This approach exposed children to many invasive radiologic examinations [44]. Since 1999, a vast amount of research has been done to demonstrate that the amount of imaging performed in these children can be safely reduced, and that the children most at risk for renal scarring can still be identified.
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| In the latest AAP UTI guidelines, VCUG is no longer recommended after the initial UTI. However, renal and bladder ultrasound is still recommended. Ultrasound is non-invasive and poses no radiation risk to the child. Moreover, a renal ultrasound is useful to screen for renal abnormalities like as hydronephrosis. If the child does have hydronephrosis, the underlying cause may need to be determined by utilizing further imaging modalities such as VCUG or MAG-3 renal imaging [42]. The AAP modified its stance on VCUG imaging after first febrile UTI because only a small number of children ultimately require surgical or medical treatment for VUR. Delaying a VCUG until UTI recurrence avoids VCUG in approximately 90% of children with a first febrile UTI. Thus, if a VCUG is performed, the likelihood that a child has high-grade VUR is greater as children at highest risk of febrile UTI recurrence are those with clinically significant VUR.
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| The NICE guidelines also recommend that all children younger than 6 months undergo an ultrasound within 6 weeks of the infection. However, the NICE guidelines differ in that ultrasonography is not recommend in children older than 6 months with an uncomplicated febrile UTI [42]. To add to the confusing aspect of UTI imaging, subsequent studies have both disputed and upheld these guidelines. For example, Ristola and Hurme conducted a retrospective review of a cohort of 672 patients younger than 3 years of age with UTI. According to their data, if the NICE guidelines had been applied to their cohort, 59 patients with VUR would have been missed and 13 of these eventually underwent surgical anti-reflux surgery [45]. In contrast, Deader ''et al'' demonstrated that the vast majority of renal anomalies demonstrated on what they deemed “inappropriate” ultrasounds were of little significance, thereby concluding the NICE imaging guidelines are safe and appropriate [46].
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| | | <br />{{familytree/start}} |
| | | {{familytree | | | | | | | | | | | | | | | | A01 | | | | | |A01=UTI classification}} |
| uti
| | {{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | }} |
| <br /> | | {{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| }} |
| {| | | {{familytree | | | | | C01 | | | | | | | | | C02 | | | | | | | | | C03 |C01=level of the infection|C02=Severity|C03=Recurrency}} |
| |+'''UTI''' | | {{familytree | | | | | |!| | | | | | | | | | |!| | | | | | | | | | |!| }} |
| ! colspan="7" |Urine analysis | | {{familytree | | | | | |!| | | | | | | | | | |!| | | | | | | | | | |!| }} |
| |- | | {{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|^|-|-|.| | | | | |,|-|^|-|-|.| | | }} |
| ! colspan="4" |first time
| | {{familytree | D01 | | D02 | | D03 | | D04 | | | | D05 | | | | D06 | | | D07 | | D01=Cystitis:infection in the bladder|D02=Pyelonephritis:infetion of the renal pelvis and kidney|D03=Urethritis:infection of the urethra|D04=Complicated|D05=Uncomplicated|D06=First time of infection|D07=recurrent infection}} |
| ! colspan="3" |recurrent eoisodes
| | {{familytree/end}} |
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| !>2 years
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| ! colspan="3" |<2years old
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| ! colspan="3" |Ultrasound
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| !Ultrasound
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| ! colspan="3" |treatment with antimicrobials
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| according to local sensitivity patterns
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| ! colspan="3" |Dimercaptosuccinic acid (DMSA) scan
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| !*if US normal tratment with antimicrobial | |
| <nowiki>*</nowiki>if Us abnormal give Ab +further managment
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| prophylaxis and prevention
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| Antibiotic prophylaxis has modest benefits, increases antibiotic resistance, and is not indicated after first or second UTI in otherwise healthy children. For children with VUR, antibiotic prophylaxis reduces UTI recurrence but does not reduce scarring.
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| Simple hygiene such as wiping front to back in females can avoid introducing bacteria into the urethral orifice
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| Active management of toilet training and constipation is important to prevent functional bladder–bowel dysfunction
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*/Most small children with febrile UTI do not develop renal damage and if they do the majority remain unchanged or regress over time.PMID: 28681079
*/Differentiating UTI from asymptomatic bacteriuria, which usually requires no treatment, can lower the frequency of unnecessary antibiotic prescriptions.PMID: 20539810
*/Febrile infants with UTIs should undergo renal and bladder ultrasonography. PMID: 26361319
*/
Some factors make it easier for bacteria to enter or stay in the urinary tract, such as:
- Vesicoureteral reflux in which urine flow backs up into the ureters and kidneys.
- Brain or nervous system illnesses (such as myelomeningocele or spinal cord injury).
- Bubble baths or tight-fitting clothes (girls).
- Changes or birth defects in the structure of the urinary tract.
- Not urinating often enough during the day.
- Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening where the urine comes out.https://medlineplus.gov/ency/article/000505.htm*
*/UTIs are more common in girls. This may occur as children begin toilet training around 3 years of age. Boys who are not circumcised have a slightly higher risk of UTIs before age 1.
10.1016/j.pcl.2006.02.011. ISSN 0031-3955
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| | | | level of the infection | | | | | | | | | Severity | | | | | | | | | Recurrency |
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| Cystitis:infection in the bladder | | Pyelonephritis:infetion of the renal pelvis and kidney | | Urethritis:infection of the urethra | | Complicated | | | | Uncomplicated | | | | First time of infection | | | recurrent infection | |
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