Urinary Tract Infection (UTI)

The urinary tract includes the kidneys, ureters (tubes that drain urine from kidneys to the bladder), bladder, and urethra. A urinary tract infection (UTI) occurs when there is growth of bacteria in the urinary tract.

During the first month of life, boys have a higher incidence of urinary tract infection; about 2.7% compared to 0.7% in girls. During this time, the incidence is higher in uncircumcised males than circumcised males. In school-age children, girls have a higher incidence of 1-3%, while the incidence in boys drops to less than 1%.

Patients can be seen by Texas Children's experts in Urology.

Causes & Risk Factors

Bacteria generally enter the urinary tract by travelling up the urethra (the tube that connects the bladder to the outside for the removal of fluids from the body). This can lead to infection of the bladder (simple cystitis). The bacteria may also travel up to the kidneys causing infection (pyelonephritis.  Vesicoureteral reflux (read more about it here) is a risk factor for developing pyelonephritis.

Symptoms & Types

Simple cystitis (infection in the bladder): In school age children, symptoms include burning with urination, increased frequency of urination, blood in the urine, new onset or increasing wetting accidents and pain in the lower abdomen. In infants, the symptoms are more subtle, and may only include irritability and decreased appetite.

Pyelonephritis (infection in the kidneys): In infants and young children, symptoms include high fever, decreased appetite, irritability, and vomiting. Older children may complain of back pain in addition to the previous symptoms.

Children who develop more than 4-5 urinary tract infections within 1 year are considered to have recurrent UTI.

Diagnosis & Tests

If there is suspicion of a UTI, your doctor will perform a urinalysis to look for certain markers of infection in the urine. If these markers are positive, or bacteria and white blood cells are seen in the urine under microscopic inspection, the urine will be sent for culture to confirm the diagnosis. A urinary tract infection cannot be diagnosed without a positive urine culture. Results from urine sent to a laboratory for culture will take about 48 hours to return. The culture lets the doctor know what kind of bacteria is growing in the urine, how much bacteria is growing and which antibiotics are the best to treat that specific infection.

In toilet-trained children, urine may be obtained by urinating directly into a specimen cup. In infants and young children who are not yet toilet trained, a catheter must be inserted to obtain a clean sample of urine.

Treatment & Care

Your doctor will likely prescribe antibiotics specific to the urinary tract bacteria to treat the acute infection. If a child cannot tolerate oral medications, or fever and symptoms do not improve, he may be hospitalized for IV (intravenous) antibiotic treatment of pyelonephritis.

Current guidelines recommend that a renal ultrasound be obtained after the first urinary tract infection with fever. If this ultrasound is abnormal, or the child has a second urinary tract infection with fever, a special test called a voiding cystourethrogram (VCUG), will be performed to see if the child has vesicoureteral reflux.

Living & Managing

Children with recurrent UTI may be prescribed a daily low dose of antibiotics to prevent infections from occurring. This is called antibiotic prophylaxis, and may be continued for a period of about 6 months. During this time, urinating (voiding) habits will be addressed with behavior modification, such as peeing on a schedule (timed voiding), controlling constipation and increasing water intake.

References & Sources

Baskin, Laurence and Barry Kogan, John Duckett. Handbook of Pediatric Urology. Philadelphia: Lippincott-Raven; 1997.

Infection and Inflammation of the Pediatric Genitourinary Tract. Campbell-Walsh Urology.  Wein, Kavoussi, Novick, Partin, Peters. 10^th edition, vol. 1. 3085-3123.