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Urinary Tract Infections

Urinary tract infection (UTI) is common in infants and children, and, if untreated, it can cause irreversible chronic renal failure urinary tract infection.


One to 2% of newborn girls and boys have UTIs. In infancy and childhood, UTI is more common in girls than in boys; 1% of school-age girls develop symptomatic infection each year. This incidence increases.

Risk factors for UTI in females include sexual intercourse, sexual abuse, use of bubble bath, constipation, pinworms, and infrequent or incomplete voiding. In either sex, risk factors include ureteric reflux in a sibling.


UTI usually is caused by bacteria that ascend up the urethra into the bladder.

Other enteric bacteria include Klebsiella, Enterococcus sp, and Staphylococcus saprophyticus (a common cause in males which can also occur in females).

Clinical Evaluation

In prepubertal children, UTI usually does not cause frequency, dysuria, or urgency. In children, symptoms of urethral irritation are more likely to be caused by bubble bath irritation, vaginitis, pinworms, masturbation, or sexual abuse.

In the newborn, signs of UTI may include late-onset jaundice, hypothermia, signs of sepsis, failure to thrive, vomiting, and fever. In infants and preschool children, additional findings include diarrhea.

The school-age child may complain of frequency, dysuria, and urgency, but enuresis, strong-smelling urine, and vomiting.

Physical Examination

The growth curve should be reviewed because children who have frequent UTIs may have a decreased rate of growth. Failure to thrive is not uncommon among infants and newborns.


Patients who have severe symptoms should be treated initially with two parenteral antibiotics that provide coverage for both gram-positive and gram-negative organisms. Agents that have not been used recently in that patient should be selected.

For children whose infections are mild, a single oral antibiotic to which the patient has not been exposed recently.

Once infection is verified, blood urea nitrogen and/or serum creatinine levels should be measured in patients who have initial infections or in any patient sick enough to be hospitalized.

A urine culture should be repeated early in the course of treatment if symptoms persist.

Most patients are treated for 10 days; those treated parenterally can be switched to oral therapy.