Urinary tract infection (UTI) is defined as the presence of bacteria in the urine along with symptoms of infection like frequent and painful urination, abdominal pain, fever, vomiting and back pain. According to the information published by the National Institute of Diabetes and Digestive and Kidney Diseases in December 2005, almost 3 percent children in the United States suffer from the disease, which accounts for more than 1 million visits to pediatric office each year. Recurrent UTIs are two or more infections over a period of six months.
Causes
In an article published in the April 1998 edition of "American Family Physician," Dr. Syed Ahmed states that Escherichia coli is the most common cause of recurrent UTIs and accounts for 80 percent of all cases. Other microorganisms include Staphylococcus sp., Streptococcus sp., Klebsiella sp., Proteus sp. and Candida albicans. The microorganism responsible for the recurrent infection is usually different from the causing the first occurrence, suggesting that each infection is a separate one.
Reduced immunity and anatomical abnormalities of the urinary tract are the major risk factors. In a study published in the October 2009 edition of "The Journal of Urology," Dr. Yoichiro Yamazaki states that in children with vesicoureteral reflux (VUR), where the urine flows backwards into the urinary tract, abnormal kidney tissue is an important predictor of early recurrent infections.
Complications
It is important that children with recurrent urinary tract infections receive careful evaluation and treatment. According to the University of Maryland Medical Center, repeated UTIs in children can lead to serious consequences like high blood pressure, kidney infection and kidney failure.
Diagnosis
For diagnosis, clean midstream urine specimen is collected. In infants, urine is aspirated from the bladder using a catheter. Presence of white blood cells in the urine sample is a satisfactory positive screening test. Many pediatricians prescribe treatment after this test.
Dr. Syed Ahmed has stated in the "American Family Physician" that confirmatory tests like urine culture are not mandatory in adolescent girls, particularly with a first episode; however, with recurrent episodes, a culture is recommended. Urine culture is followed by antimicrobial assays to specifically identify antibiotics effective against the bacteria.
Treatment
Antibiotics are the drugs of choice to treat most UTIs. Initial antibiotic therapy should be based on age, severity and location of infection, and allergy to certain antibiotics. Broad spectrum antibiotics, that can act against many different bacteria, are prescribed initially. Once the specific microorganism has been identified, antibiotics for that are effective against the particular organism are prescribed. High doses of antibiotics are usually prescribed for 5 to 10 days to treat the initial infection, followed by low doses of antibiotics for longer periods of time to prevent recurrent infections. Those children who were free of infection for over one year with low dose antibiotic therapy can slowly be weaned off the drugs says Dr. Syed Ahmed in the April 1998 edition of "American Family Physician."
Follow-up
A urine culture should be obtained three to seven days after the completion of treatment to exclude relapse. It is important to take preventive measures in all children younger than five years of age with structural abnormalities, and in children who have had three documented UTIs in one year. In an article published in a 1983 edition of "Journal of Postgraduate Medicine," Dr. K. K. Yadav recommends following-up with a physician every six weeks for at least one year in children with recurrent infections.
References
- "The Journal of Urology"; Predicting Early Recurrent Urinary Tract Infection in Pretoilet Trained Children With Vesicoureteral Reflux; Yuichiro Yamazaki, Yoshiyuki Shiroyanagi, Daisuke Matsuno, Morihiro Nishi; October 2009
- University of Maryland Medical Center: Urinary Tract Infection - Children
- American Family Physician: Evaluation and Treatment of Urinary Tract Infections in Children
- JPGM: Management of recurrent urinary tract infections in female children.
- National Kidney and Urologic Diseases Information Clearinhghouse: Urinary Tract Infections in Children
