Overview

• More common in boys until 3 months, after which incidence higher in girls.
• Most common causative organsim → escherichia coli (gram negative rod/bacilli).
• Atypical UTI:
  • Failure to respond to treatment within 48 hours.
  • Non E.coli infection → klebsiella.
  • Septic, Poor urine flow, Abdominal mass, Raised creatinine.
  • Vesicoureteric Reflux (VUR) → abnormal blackflow of urine from the bladder into the ureters and kidneys. Can lead to recurrent/atypical UTIs. Diagnosis via a micturating cystourethrogram (MCUG). (A DMSA scan may be performed to look for renal scarring - this may develop in up to 35% of children).

Making Diagnosis

Clinical Features

• Infants (<3 months) → poor feeding, vomiting, irritability.
• Young Children (3-12 months) → abdominal pain, fever, dysuria.
• Older Children (>12 months) → dysuria, frequency, haematuria.

Investigations

• Urine Dipstick → leukocytes and nitrites.
  • Nitrites → very specific and suggestive of E.coli.
  • Leucocyte Esterase → less specific. Positive in children with any febrile illness.
• Urine Culture → using appropriately collected urine (clean catch/MSU urine sample).
• (if child not of age to provide voluntary sample → use urine collection pad).

Management Plan

• <3 months old + UTI → immediate referral to paediatrician.
  • <3 Months → ADMIT. Full sepsis screen + Urine MC&S. IV Abx + Referral to paediatrician after doing.

  • 3 Months → sepsis 6 if unstable. Consider referral to paediatrician if upper UTI.

• Antibiotics ⇒
  • Lower UTI → oral trimethoprim or nitrofurantoin for 3 days.
  • Upper UTI → IV cephalexin for 7-10 days.