Urinary Tract Infections in Children

Eric Balighian; Michael Burke

doi:10.1542/pir.2017-0007

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Eric Balighian, MD*
Michael Burke, MD*

^*St Agnes Hospital, Baltimore, MD

AUTHOR DISCLOSURE
Dr Balighian has disclosed no financial relationships relevant to this article. Dr Burke has disclosed that he serves as a section editor for Contemporary Pediatrics, a monthly publication by UBM Medica, and receives a stipend for this activity. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AAP:: American Academy of Pediatrics
CFU:: colony-forming unit
DMSA:: dimercaptosuccinic acid
IV:: intravenous
UTI:: urinary tract infection
VCUG:: voiding cystourethrogram
WBC:: white blood cell

Educational Gaps

Consideration of risk factors for urinary tract infections (UTIs) in young children with fever is critical for accurate diagnosis, as well as prevention of overtesting. The use of perineal bags to collect urine from young children should be limited to specific indications in the diagnosis of UTIs. Screening for and managing bowel and bladder dysfunction reduces the risk of UTIs in older children.

Objectives

After completing this article, readers should be able to:

Recognize the risk factors for urinary tract infections (UTIs) in children.
Review the interpretation of urinalysis and urine cultures.
Review antibiotic therapy choices for UTIs.
Describe which children need imaging after febrile UTIs.
Discuss prevention strategies to discuss with families.

Case Study

Charlotte is a 13-month-old girl with a history of 2 febrile urinary tract infections (UTIs) 4 and 6 months ago. She had normal renal and bladder ultrasonographic findings 6 months ago. She presents with a fever that began yesterday. She has no other new symptoms. Her 4-year-old brother had a self-limited febrile illness 1 week ago, which resolved. At examination, she is fussy but consolable and alert. She is non–toxic appearing. Her physical examination findings show tachycardia with a heart rate of 130 beats/min, without murmur. Her respiratory rate is 28 breaths/min, without distress or retractions. Her lungs are clear bilaterally. Her tympanic membranes appear normal. Her abdomen is soft and nontender. Her genital examination findings appear normal, without erythema or labial adhesions. Her temperature is 102.5°F (39.2°C). A bag is placed …