Urinary Tract Infection (UTI) in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

UTI is an infection affecting any part of the urinary system, including the bladder (cystitis) and kidneys (pyelonephritis). Common in children, especially infants.

Aetiology

Most UTIs in children are bacterial, primarily caused by Escherichia coli (E. coli). Other bacteria include:

• Klebsiella species
• Proteus species
• Enterococcus species

Pathophysiology

Bacteria enter the urinary tract, multiplying in the bladder (cystitis) or ascending to the kidneys (pyelonephritis). Untreated pyelonephritis may lead to kidney damage.

Risk Factors

• Female gender – shorter urethra allows easier bacterial entry.
• Age – more common in young children.
• Vesicoureteral reflux (VUR), constipation, poor perineal hygiene, and uncircumcised males.

Signs and Symptoms

• Infants: Fever, irritability, poor feeding, foul-smelling urine.
• Older children: Dysuria, frequency, suprapubic pain, fever, back pain (if pyelonephritis).

Investigations

• Urine dipstick: Detects leukocytes, nitrites, and blood.
• Urine culture: Confirms bacterial growth and sensitivity.
• Ultrasound: For recurrent cases or children under 6 months.

Management

Treatment includes antibiotics and supportive care:

Antibiotic Treatment:

• Trimethoprim: 3-5 days for lower UTI.
• Nitrofurantoin: 3-5 days for lower UTI, avoid in infants <3 months.
• Amoxicillin or Co-amoxiclav: 7-10 days for upper UTI (pyelonephritis).

Supportive Care:

• Hydration: Encourage fluid intake to flush out infection.
• Fever/pain management: Paracetamol or ibuprofen.

Referral to Specialist:

Children with recurrent UTIs or abnormal imaging may need referral to a paediatrician or paediatric nephrologist.

References

1. NICE (2024). Urinary Tract Infection in Children: Diagnosis and Management. Available at: NICE Guidance
2. NHS (2023). Urinary Tract Infections in Children. Available at: NHS
3. British Medical Journal (2023). Management of Paediatric UTIs. Available at: BMJ