Tuesday, October 4, 2022

Urinary Tract Infection In Children

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Can Utis In Children Be Prevented

Urinary Tract Infections in Children (UTIs)

There are several things you can do to help prevent your child from developing a UTI:

  • Practice good hygiene to prevent the spread of bacteria from the gut to the urinary tract. When wiping a girls bottom after a poo, it is important to always wipe from front to back .
  • Being constipated can also increase the risk of developing a UTI, so if your child is constipated, see your doctor or pharmacist.
  • Make sure your child is hydrated by offering them plenty of fluids to drink.
  • Regularly change their nappy.

How Do Healthcare Providers Test Uti In Children

Culture

Any UTI in children or in adults is tested by a simple urine examination. Urine examination is a mirror image of the kidney. So the urine test will tell us whether there is a pus cell in the urine, WBC or nitrite test is positive, what is the pH of the urine, whether there is any RBC in the urine associated with bleeding in the urine.

For all this, we have a urinary culture. In the urinary culture, we find out what kind of organism is causing the urinary tract infection. The most common commutated infection is because of E. coli which is presented in the gut. Some are hospital-acquired infections like klebsiella, pseudomonas. This occurs when we do a characterization or any other procedure in the hospital so it is known as hospital-acquired infections.

Colony count

So culture tells about the type of organism it tells about what is a colony count, whether the organism is a significant amount to cause infection. So the colony count should be more than 105to be called significant.

Culture sensitivity

Third, the culture and sensitivity tell about what antibiotics the organism is sensitive to so that we can prescribe the same group of the same antibiotic which is most effective and treat the urinary tract infection.

Ultrasound

If we suspect there is a reflux of the urine then we do an MCUG. In which we put a catheter into the bladder and put a dye and do the X-ray. So with this, we know the grade of the reflex, or whether there is reflux prevention or not or DRUG.

Urine Sample Collection: Precontinent Children

Young children in Western society generally do not achieve urinary continence until 23 years old, so other collection methods are required for precontinent children. Non-invasive methods involve waiting for spontaneous urine voiding, then opportunistic collection with a nappy pad, bag, or clean catch of the urine stream. These methods seem convenient and practical. However, pads and bags have high rates of contamination up to 50%60%, understandable given their close contact with skin under the nappy area. Pad and bag samples can be useful for dipstick screening but are unreliable for culture. Cotton wool ball collection is specifically discouraged. Clean catch has the lowest contamination of all non-invasive methods at around 25%, but attempts can be time-consuming or unsuccessful. Simple voiding stimulation methods such as the Quick-Wee technique can increase the speed and success of clean catch.

Invasive methods extract urine directly from the bladder by urethral catheterisation or suprapubic needle aspiration . These methods are effective but require expertise and equipment to perform and are painful and distressing for the child. Contamination from catheter and SPA is low, at 10% and 1% respectively, so these methods are more reliable for culture and diagnosis.

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Why Do Children Feel Pain During Urination / What Causes A Urinary Tract Infection In A Child

During infection the urine becomes acidic and there is inflammation in the mucosa. So whenever they pass acidic urine, it burns or hurts. This pain while passing urine in Medical terms is known as dysuria. The infection in the urine. This infectious urine touches the congested mucosa and causes pain during urination.

Recurrent Uti: Prophylaxis And Prevention

Young children under the age of 5 are at the risk of ...

There are few pragmatic strategies to reduce the risk of recurrent UTI in children. Circumcision reduces the risk of UTI in males, but involves surgery, with a number needed to treat of > 100to prevent one UTI. There is insufficient evidence to support cranberry prophylaxis or probiotics. Antibiotic prophylaxis has modest benefits, increases antibiotic resistance and is not indicated after first or second UTI in otherwise healthy children. For children with VUR, antibiotic prophylaxis reduces UTI recurrence but does not reduce scarring. Simple hygiene such as wiping front to back in females can avoid introducing bacteria into the urethral orifice. Active management of toilet training and constipation is important to prevent functional bladderbowel dysfunction.

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Risk Factors For Uti In Children

UTIs occur more often in girls, especially when toilet training begins. Girls are more susceptible because their urethras are shorter and closer to the anus. This makes it easier for bacteria to enter the urethra. Uncircumcised boys under 1 year old also have a slightly higher risk of UTIs.

The urethra doesnt normally harbor bacteria. But certain circumstances can make it easier for bacteria to enter or remain in your childs urinary tract. The following factors can put your child at a higher risk for a UTI:

  • a structural deformity or blockage in one of the organs of the urinary tract
  • abnormal function of the urinary tract
  • vesicoureteral reflux, a birth defect that results in the abnormal backward flow of urine
  • the use of bubbles in baths
  • tight-fitting clothes

Treatment For More Severe Utis

Kids with a more severe infection may need treatment in a hospital so they can get antibiotics by injection or IV .

This might happen if:

  • the child has high fever or looks very ill, or a kidney infection is likely
  • the child is younger than 6 months old
  • bacteria from the infected urinary tract may have spread to the blood
  • the child is dehydrated or is vomiting and cannot take any fluids or medicine by mouth

Kids with VUR will be watched closely by the doctor. VUR might be treated with medicines or, less commonly, surgery. Most kids outgrow mild forms of VUR, but some can develop kidney damage or kidney failure later in life.

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What Causes A Urinary Tract Infection In Toddlers

Normal urine is sterile and contains fluids, salts and waste products. An infection occurs when microorganisms cling to the opening of the urethra and begin to multiply. Most infections arise from Escherichia coli bacteria that normally live in the digestive tract.

Different bacteria can cause a urinary tract infection. The seven most common bacteria include the following:

  • Escherichia coli , found in about 85% of UTIs in children.
  • Klebsiella.
  • Pain in the back or side .
  • Fatigue.

Check If It’s A Urinary Tract Infection

Meet the Experts: Urinary Tract Infections UTIs in Kids.

Symptoms of a UTI may include:

  • pain or a burning sensation when peeing
  • needing to pee more often than usual during the night
  • pee that looks cloudy
  • needing to pee suddenly or more urgently than usual
  • needing to pee more often than usual
  • lower tummy pain or pain in your back, just under the ribs
  • a high temperature, or feeling hot and shivery
  • a very low temperature below 36C

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Reflux: A State Of Flux

Historical approaches assumed VUR could lead to significant long-term renal damage, therefore should be identified early. There is now increasing awareness that much of the renal disease based on reflux is congenital, with an appreciation of mild hydronephrosis and VUR as likely normal physiological states that resolve spontaneously. Given that lower grade reflux is unlikely to cause clinically significant scarring, and mild scarring without other risk factors is unlikely to cause long-term renal dysfunction, aggressive identification of all VUR is unwarranted. Active management strategies should still be considered for higher grade VUR .

Five-year-old girl with unilateral grade 4 vesicouretric reflux on voiding cystourethrogram. Image courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 2722.

Can Utis Be Prevented

These tips can help prevent UTIs:

  • In infants and toddlers, change diapers often to help prevent the spread of bacteria that cause UTIs. When kids are potty trained, it’s important to teach them good hygiene. Girls should know to wipe from front to rear not rear to front to prevent germs from spreading from the anus to the urethra.
  • School-age girls should avoid bubble baths and strong soaps that might cause irritation. They also should wear cotton underwear instead of nylon because it’s less likely to encourage bacterial growth.
  • All kids should be taught not to “hold it” when they have to go. Pee that stays in the bladder gives bacteria a good place to grow.
  • Kids should drink plenty of fluids but avoid those with caffeine.

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Eating Diet & Nutrition

Food choices do not help prevent or treat bladder infections in children, but drinking plenty of liquids may help. Talk with a health care professional about how much liquid your child should drink, depending on his or her age, size, and other health conditions.

The National Institute of Diabetes and Digestive and Kidney Diseases and other components of the National Institutes of Health conduct and support research into many diseases and conditions.

Urinary Tract Infection In Children

Say Bye to UTI

Overview of urinary tract infection in children

A urinary tract infection in children is a fairly common condition. Bacteria that enter the urethra are usually flushed out through urination. However, when bacteria arent expelled out of the urethra, they may grow within the urinary tract. This causes an infection.

The urinary tract consists of the parts of the body that are involved in urine production. They are:

  • two kidneys that filter your blood and extra water to produce urine
  • two ureters, or tubes, that take urine to your bladder from your kidneys
  • a bladder that stores your urine until its removed from your body
  • a urethra, or tube, that empties urine from your bladder to outside your body

Your child can develop a UTI when bacteria enter the urinary tract and travel up the urethra and into the body. The two types of UTIs most likely to affect children are bladder infections and kidney infections.

When a UTI affects the bladder, its called cystitis. When the infection travels from the bladder to the kidneys, its called pyelonephritis. Both can be successfully treated with antibiotics, but a kidney infection can lead to more serious health complications if left untreated.

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A Pharmacist Can Help With Utis

You can ask a pharmacist about treatments for a UTI. A pharmacist can:

  • offer advice on things that can help you get better
  • suggest the best painkiller to take
  • tell you if you need to see a GP about your symptoms

Some pharmacies offer a UTI management service and can prescribe antibiotics if they’re needed.

What Causes Urinary Tract Infections In Children

Urinary Tract Infections are often caused by bacteria which may get entrance. The most known cause of Urinary Tract Infections is Escherichia coli, which mostly has its origin is the intestines.

UTIs in children are much less common in boys and more common in girls because a girls urethra is shorter and closer to the anus. In boys, its more common in Uncircumcised boys who are younger than one year of age.

When bacteria are found in the skin in large numbers around the rectal area and in stools, they may travel up the urethra into the bladder. The bacteria then multiply and cause infection. This infection is called causes the Lower Urinary Tract Infection.

If the bacteria travel up from the bladder to the kidneys and multiply, they cause the kidney UTI which is called pyelonephritis. Kidney UTIs are severe than bladder infections, and may cause greater injury in the kidney, especially in children.

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What Is The Urinary Tract And How Does It Normally Work

The urinary tract is the kidneys, ureters, bladder, and urethra.

The kidneys filter and remove waste and water from the blood to produce urine. The urine travels from the kidneys down 2 narrow tubes called the ureters. The urine is then stored in the bladder.

When your child does a wee, urine flows out of the body through the urethra, a tube at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls.

Front view of the urinary tract

Side view of the female urinary tract

Side view of the male urinary tract

What Are The Treatments For Utis

Urinary tract infections in children – Expert opinion

Antibiotics, mainly. These medications kill bacteria. Kids usually take them for anywhere from 3 to 10 days . Your doctor might do another urine test after your child finishes the medicine to see if the infection has cleared up.

Make sure your child finishes all of their meds, even if they start to feel better. Stopping too soon can make germs resistant to antibiotics and cause another infection.

Most UTIs clear up in about a week. Some kids will have symptoms for a few weeks. Call your doctor if your child’s symptoms don’t start to improve after 3 days from when they started on antibiotics, or if they get worse.

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Virulence Factors Of Pathogens

Virulence factors of pathogens increase the likelihood that a specific bacterial strain will colonize and subsequently invade the urinary tract. These factors include -hemolysin, M hemagglutinin, endotoxin, cytotoxic necrotizing factor 1, K capsular antigen, a rigid cell wall, serum resistance ability due to the outer membrane protein TraT, aerobactin which supports growth by chelating iron, and adhesive capacity . The three different types of adhesins identified on uropathogenic E. coli include type 1 pili , P-fimbriae and X-adhesins . These adhesins facilitate adherence of the bacteria to mucosal receptors in the uroepithelium in spite of the flushing action of urine flow . Once the uroepithelium is invaded, an intracellular biofilm is formed . The biofilm can protect the uropathogenic E. coli from the host immune system .

Causes Of Urinary Tract Infections

UTIs are usually caused by bacteria from poo entering the urinary tract.

The bacteria enter through the tube that carries pee out of the body .

Women have a shorter urethra than men. This means bacteria are more likely to reach the bladder or kidneys and cause an infection.

Things that increase the risk of bacteria getting into the bladder include:

  • having sex
  • do not use scented soap

  • do not hold your pee in if you feel the urge to go

  • do not rush when going for a pee try to fully empty your bladder

  • do not wear tight, synthetic underwear, such as nylon

  • do not drink lots of alcoholic drinks, as they may irritate your bladder

  • do not have lots of sugary food or drinks, as they may encourage bacteria to grow

  • do not use condoms or diaphragms with spermicidal lube on them try non-spermicidal lube or a different type of contraception

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Prognosis For Uti In Children

Properly managed children rarely progress to renal failure unless they have uncorrectable urinary tract abnormalities. However, repeated infection, particularly in the presence of VUR, is thought to cause renal scarring, which may lead to hypertension and end-stage renal disease. In children with high-grade VUR, long-term scarring is detected at a 4- to 6-fold greater rate than in children with low-grade VUR and at an 8- to 10-fold greater rate than in children without VUR. The risk of scarring after recurrent UTI is as high as 25%, or 10- to 15-fold greater than that in children with only 1 febrile UTI however, few children will have recurrent febrile UTI.

What Can I Do To Prevent Infections

Urinary Tract Infection (UTI) In Children

You should have the child:

  • Go to the bathroom often and take the time to empty the bladder
  • Use good hygiene. Girls should wipe from front to back.
  • Have daily, soft bowel movements. If constipation is present, it needs to be treated.
  • Drink lots of fluids
  • Avoid bubble baths or harsh soaps that could be irritating to the skin

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Recurrent Utis In Children

A small number of children have recurring UTIs. If your child’s had a UTI before, it’s important that both of you watch for the return of any associated symptoms.

Tell your GP about any symptoms as soon as possible so a diagnosis can be confirmed and treatment can begin.

If your child has a problem that increases their risk of UTIs, such as faulty valves that allow urine to flow the wrong way, they may be prescribed low-dose antibiotics as a long-term measure to prevent further infections.

Etiology Of Uti In Children

Predisposing factors in younger children include

  • Malformations and obstructions of the urinary tract

are the most frequently implicated gram-positive organisms.

Fungi and mycobacteria are rare causes, occurring in immunocompromised hosts.

Adenoviruses rarely cause UTIs, and when they do, the disorder is predominantly hemorrhagic cystitis among immunocompromised hosts.

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How Are Utis Diagnosed In Children

A urine sample is needed to check if your child has a UTI. Your childs doctor or nurse will guide you on how to do this.

Once collected, your childs urine sample is usually first tested by dipping a special paper strip into the urine to check for a colour change that can indicate an infection. The doctor may also send the urine sample to a laboratory to check which bacteria are causing the infection and which antibiotic will be most effective against your childs UTI. These results may take up to 48 hours to return. Sometimes your child will need an ultrasound to check for any problems with the bladder or kidneys.

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