Urinary Tract Infection in Children

UTI occurs in children with a prevalence of 1-3% in girls and 1% in boys.
In girls, UTI occurs by the age of 5 years whereas in boys mostly UTI occur during 1st year of life.
Most commonly UTI causative organisms are colonic bacteria like E.Coli, Klebsiella, Proteus etc. which are more common in girls and Proteus infection in boys.

UTI can present in 3 forms:
• Pyelonephritis
• Cystitis
• Asymptomatic bacteriuria

Pyelonephritis: it is the infection of urinary system involving upper urinary tract (kidneys). It presents with:
• Abdominal/back pain
• Fever
• Malaise
• Nausea
• Vomiting
Renal parenchymal involvement can lead to renal scarring means affecting kidneys.

Cystitis: it is the infection of urinary bladder. It presents with:
• Dysuria (painful urination)
• Increased frequency of passing urine
• Urgency
• Lower abdominal pain
• Loss of control on urine
Cystitis does not cause fever and does not result in renal injury.
Most UTIs are ascending infection. The bacteria arise from the fecal flora, colonize the anal area and enter the bladder via urethra.

In uncircumcised boys, the bacterial pathogens arise from flora beneath the prepuce.

Risk factors for UTIS:
• Uncircumcised males
• Female gender
• Vesicoureteral reflux
• Toilet training
• Urethral instrumentation
• Wiping from back to front in girls
• Bubble bath
• Tight clothing
• Pinworm infection
• Anatomic abnormality
• Sexual activity
• Pregnancy

Diagnosis:
• Urine culture is necessary for confirmation of UTI

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