UTI in Children



Background

  • UTI cannot be diagnosed on symptoms alone
  • Growth is required to confirm (dipstick has inadequate sensitivity/specificity)
  • If child is unwell, finding a UTI does not exclude another septic focus (e.g. meningitis) (2% of children have asymptomatic bacturia)
  • Dipstick test is for screening only:
    • Blood & protein are unreliable markers of UTI
    • Some bacteria do not produce nitrates
    • Infants may not have pyuria even with confirmed UTI
    • Leukocytes may appear in urine with many other (e.g. meningitis/AOM) infections


Clinical

  • In infants, features are often non-specific (e.g. irritability, vomiting, poor feeding)
  • Older children may report loin or abdominal pain, frequency and dysuria
  • Full "septic" clinical examination (ENT, neurological, respiratory abdominal exam etc.)
  • Remember to continue to search for clinical pneumonia / meningitis etc even if bacturia is found
Quick Wee (http://www.bmj.com/content/357/bmj.j1341)
Quick Wee (from BMJ)

Investigations

  • Never use a urine bag
  • MSU if child old enough
  • In infants, use the Quick-Wee method in preference to clean catch
  • Suprapubic aspirate if cannot wait (unwell++) for clean catch
  • Catheter specimen only after fail SPA
  • FBC, cultures, U&E, CRP if clinically unwell

Management

  • If unwell or all < 6/12 = admit paediatrics (IV antibiotics)
  • IV fluids
  • LP if clinical meningitis
  • Usually start with IV gentamicin and penicillin (check with paediatrics)
  • PO trimethoprim or cephalexin if older child and clinically well AFTER MSU sent for culture
  • Admit paediatrics if <6/12, unwell, renal or medical history, recurrent UTI

Follow up (GP)

Renal US

  • Unwell, slow to respond or those <3/12
  • <6/12 US within 1 month
  • Older children with mild UTI do not need US on first UTI but will require renal imaging on second / recurrent UTI

Paediatric OPD

  • All children with proven UTI


Content by Dr Íomhar O' Sullivan . Last review Dr ÍOS 16/06/21.