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Urinary tract infection in children

Urinary tract infection (UTI) is broadly speaking the presence of bacteria in the urinary tract (in a significant amount!) Accompanied by symptoms (as opposed to asymptomatic bacteriuria, which does not require treatment). These infections are very common, well! UTIs are one of the most common bacterial infections in children. Here you have to find the reasons and treatments for Urinary tract infection in children.

Among parents, it is often referred to as bladder inflammation or cold. This is not always an accurate phrase, but more on that in a moment.

Importantly, the diagnosis of UTIs is not always obvious. It is a disease that you cannot really see “on the outside” – such as runny nose, cough or vomiting. 

While older children are more likely to experience typical symptoms associated with this disease (pain, burning when urinating, pollakiuria, sudden urge to urinate Q- i.e. dysuria symptoms), they may not be observed in the youngest. 

Or the babies in the world simply won’t tell us about them. In this group of toddlers, the symptoms of infection are very non-specific, so when something is wrong, or the toddler has a fever for no other reason, we should always have this unfortunate UTI in the back of our head. 

So as you can see, these symptoms are actually very non-specific, and remember that they may or may not be a UTI. Therefore, in all children by the end of the second year of life with fever with no apparent reason, at least a general urinalysis should be performed to exclude a UTI. 

In a meta-analysis evaluating the usefulness of symptoms for the diagnosis of UTIs, it was found that in the case of children up to 2 years of age, the most important indication for a physician was fever for over 2 days without any other reason.

Why is it so important?  

Unrecognized urinary tract infection in babies carries the risk of its generalization – that is, the passage of bacteria outside the urinary system – into the blood (we are talking then about urosepsie). 

In addition, failure to diagnose on time and delay of treatment poses the risk of post-inflammatory scars in the kidneys. If, on the other hand, UTIs are excluded and the child is in good condition, then you can wait while observing the child until symptoms suggesting the cause of the fever appear or … the fever has passed. 

Generally, urinary tract infections can, in theory, be divided into upper and lower tract infections – depending on which part is “sick” symptoms may be slightly different.

Upper urinary tract infection (acute pyelonephritis, acute tubulointerstitial nephritis).

Includes renal pelvis and renal interstitium. There is usually an acute onset, body temperature> 38 ° C, abdominal pain or tenderness in the lumbar region (determined by your doctor on physical examination as a positive Goldflam sign).

Infection of the lower urinary tract (cystitis)

Inflammation of the bladder, characterized by symptoms of dysuria, frequent urination, urgency, enuresis, pain in the suprapubic region, an unpleasant urine odor, and sometimes even hematuria.

BUT! In children under 2 years of age, it is often difficult to determine the location of the infection, and we treat all children of this age with UTI as patients with pyelonephritis. 

So how do you recognize this infection when you suspect it?

By doing urine tests. The test that suggests a UTI is a general urine test, while the confirmatory test is a microbiological test, i.e. seeds. In the general urine examination, the evidence of UTI is an increased number of leukocytes in the urine sediment (leukocyturia) (over 5-10 wpw – in the field of view) and the possible presence of nitrites. During the infection, red blood cells and protein may also appear in the urinalysis. 

On the other hand, UTI is not evidenced by the presence of bacteria, as a certain amount of bacteria in the general urine test is physiological. However, when it comes to the presence of bacteria in the culture, this is what the urinary tract infection confirms, and as such confirmation we consider the growth of bacteria in a significant amount. 

What does it mean? For midstream urine, significant bacteriuria is defined as an increase of more than 100,000 (10 ^ 5) colonies of uropathogenic bacteria in 1 mL of urine.

It is very important that urine culture should be performed each time a urinary tract infection is suspected BEFORE starting treatment. * This is due to the fact that, as I mentioned, only the culture confirms UTI and administration of even one dose of an antibiotic (or chemotherapy) may falsify its result . 

In any case, a positive culture result requires reference to the urinalysis result and the patient’s condition. 

Therefore, the results of urine tests should always be consulted with your doctor, preferably the one who ordered them.

In adolescents who develop the typical symptoms of a lower urinary tract infection for the first time in their life, only a general urine test may be performed initially. 

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