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American Academy of Pediatrics
Article

Urinary Tract Infections in Children: Knowledge Updates and a Salute to the Future

Elizabeth C. Jackson
Pediatrics in Review April 2015, 36 (4) 153-166; DOI: https://doi.org/10.1542/pir.36-4-153
Elizabeth C. Jackson
Departments of Urology and Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  1. Elizabeth C. Jackson, MD
  1. Departments of Urology and Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
  • AUTHOR DISCLOSURE

    Dr Jackson has disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

  • Abbreviations:
    AAP:
    American Academy of Pediatrics
    BBD:
    bladder and bowel dysfunction
    DMSA:
    dimercaptosuccinic acid
    IBC:
    intracellular bacterial communities
    NC:
    nuclide cystography
    PAC:
    proanthocyanidin
    QIR:
    quiescent intracellular reservoirs
    RIVUR:
    Randomized Intervention for Children with Vesicoureteral Reflux
    TLR-4:
    Toll-like receptor 4
    UTI:
    urinary tract infection
    VCUG:
    voiding cystourethrography
  • Educational Gaps

    1. Evaluating and treating bladder and bowel dysfunction are critical in reducing the risk of urinary tract infections (UTIs).

    2. The pathogenesis of Escherichia coli infections reveals that quiescent intracellular reservoirs may be antibiotic-protected sources of recurrent infections.

    Objectives

    1. Review the documentation of UTI and the importance of the urine culture.

    2. Understand the controversy over imaging and management of febrile UTIs in children.

    3. Recognize the risk factors for recurrent UTIs and strategies for intervention.

    4. Update information on the pathogenesis of E coli UTIs.

    Case Scenario

    Ellie is a 7-year-old girl with frequent urinary tract infections (UTIs): 3 in the past 6 months. Her first UTI was discovered at age 3 years. Symptoms include an increase in daytime wetting accidents, dysuria, and foul urine odor. She has not had fever. The culture has yielded Escherichia coli resistant to ampicillin and trimethoprim-sulfamethoxazole. The family denies that Ellie has constipation when she has a daily bowel movement. Even without UTIs, she has urgency, squatting, and damp panties during the day. She wipes front to back and takes showers not baths. She is overweight and has been treated with nystatin cream for perineal redness and itching 3 times. At night she has always wet the bed and wears pull-ups. Her evaluation includes normal renal ultrasonographic findings. Family history reveals that her father wet the bed as a child and still goes to the bathroom often. Her mother says she hates to go on a road trip with Ellie and her father because “they know every bathroom between here and Memphis.” The mother has had several UTIs. Ellie’s younger sister had a febrile UTI at age 3 months and was diagnosed as having …

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    Pediatrics in Review: 36 (4)
    Pediatrics in Review
    Vol. 36, Issue 4
    1 Apr 2015
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    Urinary Tract Infections in Children: Knowledge Updates and a Salute to the Future
    Elizabeth C. Jackson
    Pediatrics in Review Apr 2015, 36 (4) 153-166; DOI: 10.1542/pir.36-4-153

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    Urinary Tract Infections in Children: Knowledge Updates and a Salute to the Future
    Elizabeth C. Jackson
    Pediatrics in Review Apr 2015, 36 (4) 153-166; DOI: 10.1542/pir.36-4-153
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    • Article
      • Educational Gaps
      • Objectives
      • Case Scenario
      • Just the Stats, Please
      • UTI Symptoms
      • UTI Treatment
      • Imaging After a UTI and Considerations for the Management of Reflux
      • Relatively Hot Off the Press! The First of the RIVUR Study Results
      • Surgical Repair of Reflux
      • Imaging Modalities for the Urinary Tract
      • An Update on Breaking the Cycle of Recurrent UTIs
      • Alternative Prevention Strategies
      • Pathogenesis of E coli UTI
      • Genetic Determinants of Risk of UTI
      • Case Scenario Continued
      • References
    • Figures & Data
    • Info & Metrics
    • Comments
    • Quiz

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