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Urinary tract infection is a result
of the growth of bacteria within the child's urinary tract.
This will usually cause varying degrees of inflammation
of such organs as the kidneys or bladder. The most reliable
means of diagnosis is made by obtaining a urine culture.
Even this method is not foolproof, as the urine may be
contaminated by bacteria on the child's skin when voiding.
Occasionally, to avoid confusion and assure greater diagnostic
accuracy, a urine sample can be obtained by passing a
small urethral catheter or performing a suprapubic needle
aspiration. The bacteria causing these infections are
present in the child's own intestinal tract and probably
ascend into the urinary tract. They are absolutely not
contagious to others.
Symptoms Associated with Urinary Tract
Infections
Symptoms are often misleading. In infants
(less than 2 years old) they are usually non-specific
and may not focus your attention towards the urinary tract.
On the other hand, urinary frequency and discomfort associated
with voiding in children may simply result from irritations
that mimic a urinary tract infection. It is essential
to obtain a urine culture to both avoid missing the diagnosis
of UTI, as well as overdiagnosing UTI in children.
| INFANTS (<2) |
CHILDREN (>2) |
| Fever |
Fever |
| Irritability |
Frequency, Urgency |
| Malodorous Urine |
Wetting |
| Failure to Thrive |
Burning |
What radiologic studies are indicated
in children with Urinary Tract Infection?
A history and physical exam is not
sufficiently accurate to evaluate the child's urinary
tract. Adequate evaluation of the "upper" and
"lower" urinary tract requires the proper selection
of different radiologic studies. The initial study should
be a voiding cystourethroeram (VCUG) to demonstrate the
anatomy of the "lower" urinary tract. The VCUG
is performed by placing a small catheter into the bladder
and allowing a water-like contrast material to pass through
the catheter filling the bladder. A few X-ray films are
taken during bladder filling and voiding to observe for
reflux or urine. The "upper" urinary tract may
require one or more of the following studies:
- An IVP demonstrates the anatomy
and some information as to the function and drainage
of the kidneys. An injection (needle) of iodine contrast
into the child's vein precedes the X-rays.
- A Renal Ultrasound can visualize
the kidneys and rule out obvious obstructions. There
are no injections or catheters necessary for this test.
- A Renal Scan, performed in the Nuclear
Medicine Department, is mot accurate in estimating kidney
function and drainage, as well as detecting evidence
of kidney involvement (scarring). An injection of radioisotope
into the child's vein is required before scanning.
How are Urinary Tract Infections Treated?
Prompt and effective treatment followed
by adequate evaluation of the urinary tract is essential
to minimize your child's discomfort and risk of urinary
tract damage. Your physician will usually prescribe an
oral antibiotic for a period of 5-7 days to treat a "simple"
UTI. To treat a more "complicated" UTI (babies
less than 2 months old, child appears ill, high fevers,
poor response to initial oral antibiotic), your physician
may decide to hospitalize your child and begin intravenous
antibiotics. In these cases where a kidney infection is
suspected, the course of antibiotics will be 10-14 days.
Unfortunately, it is not uncommon for a urinary tract
infection to recur (especially in girls) after initially
adequate antibiotic treatment, even with normal radiologic
studies. This may be most perplexing to parents and physicians,
but there is little chance of significant damage to the
urinary system when the radiologic studies are normal.
Further invasive studies such as cystoscopy, urethral
dilation or repeat VCUG are not indicated or useful. It
is important to have your physician perform follow-up
urine cultures whenever another UTI is suspected. and
routinely every 3 months for at least one year following
treatment. There are children who demonstrate a strong
tendency towards recurrent UTI (>3/year) and 1 recommend
continuous low dose antibiotic prophylaxis, as a nightly
dose for at least 6 months.
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