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

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 …