Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1992 Nov;157(5):554–561.

Urinary tract infections in children. An update.

I Zelikovic 1, R D Adelman 1, P A Nancarrow 1
PMCID: PMC1022035  PMID: 1441497

Abstract

Urinary tract infection is a common and frequently recurring condition in children. The susceptibility of the host, the presence of urinary tract abnormalities, and the virulence of the urinary pathogens are of primary importance in the development of the infection. Renal parenchymal scarring, hypertension, and renal insufficiency are well-established complications of the infection in children. To reduce the risk of renal damage, diagnosis and treatment must be prompt. The diagnosis demands radiologic evaluation of the urinary tract in all boys, all children younger than 5 years, all patients with voiding dysfunction, and school-aged girls with recurrent infection to identify those patients with vesicoureteral reflux, obstruction, or other urinary tract abnormalities. Both voiding cystourethrography and renal ultrasonography are the initial examinations to use to determine the next appropriate study. Children with vesicoureteral reflux or with recurrent urinary tract infections should receive prophylactic antibiotic therapy and should be observed closely to prevent renal scarring.

Full text

PDF
560

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adelman R. D. The dipslide in diagnosis of urinary tract infections. J Fam Pract. 1976 Dec;3(6):647–649. [PubMed] [Google Scholar]
  2. Aladjem M., Boichis H., Hertz M., Herzfeld S., Raviv U. The conservative management of vesicoureteric reflux: a review of 121 children. Pediatrics. 1980 Jan;65(1):78–80. [PubMed] [Google Scholar]
  3. Aronson A. S., Gustafson B., Svenningsen N. W. Combined suprapubic aspiration and clean-voided urine examination in infants and children. Acta Paediatr Scand. 1973 Jul;62(4):396–400. doi: 10.1111/j.1651-2227.1973.tb08126.x. [DOI] [PubMed] [Google Scholar]
  4. Bartlett R. C., O'Neill D., McLaughlin J. C. Detection of bacteriuria by leukocyte esterase, nitrite, and the automicrobic system. Am J Clin Pathol. 1984 Dec;82(6):683–687. doi: 10.1093/ajcp/82.6.683. [DOI] [PubMed] [Google Scholar]
  5. Berg U. B., Johansson S. B. Age as a main determinant of renal functional damage in urinary tract infection. Arch Dis Child. 1983 Dec;58(12):963–969. doi: 10.1136/adc.58.12.963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Björgvinsson E., Majd M., Eggli K. D. Diagnosis of acute pyelonephritis in children: comparison of sonography and 99mTc-DMSA scintigraphy. AJR Am J Roentgenol. 1991 Sep;157(3):539–543. doi: 10.2214/ajr.157.3.1651644. [DOI] [PubMed] [Google Scholar]
  7. Blickman J. G., Taylor G. A., Lebowitz R. L. Voiding cystourethrography: the initial radiologic study in children with urinary tract infection. Radiology. 1985 Sep;156(3):659–662. doi: 10.1148/radiology.156.3.4040642. [DOI] [PubMed] [Google Scholar]
  8. Cohen M. The first urinary tract infection in male children. Am J Dis Child. 1976 Aug;130(8):810–813. doi: 10.1001/archpedi.1976.02120090020004. [DOI] [PubMed] [Google Scholar]
  9. Coppa G. V., Gabrielli O., Giorgi P., Catassi C., Montanari M. P., Varaldo P. E., Nichols B. L. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells. Lancet. 1990 Mar 10;335(8689):569–571. doi: 10.1016/0140-6736(90)90350-e. [DOI] [PubMed] [Google Scholar]
  10. Cremin B. J. Observations on vesico-ureteric reflux and intrarenal reflux: a review and survey of material. Clin Radiol. 1979 Nov;30(6):607–621. doi: 10.1016/s0009-9260(79)80003-3. [DOI] [PubMed] [Google Scholar]
  11. Demetriou E., Emans S. J., Masland R. P., Jr Dysuria in adolescent girls: urinary tract infection or vaginitis? Pediatrics. 1982 Aug;70(2):299–301. [PubMed] [Google Scholar]
  12. Dinkel E., Orth S., Dittrich M., Schulte-Wissermann H. Renal sonography in the differentiation of upper from lower urinary tract infection. AJR Am J Roentgenol. 1986 Apr;146(4):775–780. doi: 10.2214/ajr.146.4.775. [DOI] [PubMed] [Google Scholar]
  13. Fine J. S., Jacobson M. S. Single-dose versus conventional therapy of urinary tract infections in female adolescents. Pediatrics. 1985 May;75(5):916–920. [PubMed] [Google Scholar]
  14. Gillenwater J. Y., Harrison R. B., Kunin C. M. Natural history of bacteriuria in schoolgirls. A long-term case-control study. N Engl J Med. 1979 Aug 23;301(8):396–399. doi: 10.1056/NEJM197908233010802. [DOI] [PubMed] [Google Scholar]
  15. Ginalski J. M., Michaud A., Genton N. Renal growth retardation in children: sign suggestive of vesicoureteral reflux? AJR Am J Roentgenol. 1985 Sep;145(3):617–619. doi: 10.2214/ajr.145.3.617. [DOI] [PubMed] [Google Scholar]
  16. Glennon J., Ryan P. J., Keane C. T., Rees J. P. Circumcision and periurethral carriage of Proteus mirabilis in boys. Arch Dis Child. 1988 May;63(5):556–557. doi: 10.1136/adc.63.5.556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Goldraich N. P., Ramos O. L., Goldraich I. H. Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol. 1989 Jan;3(1):1–5. doi: 10.1007/BF00859614. [DOI] [PubMed] [Google Scholar]
  18. Gordon I. Use of Tc-99m DMSA and Tc-99m DTPA in reflux. Semin Urol. 1986 May;4(2):99–107. [PubMed] [Google Scholar]
  19. Griffith D. P. Infection-induced renal calculi. Kidney Int. 1982 Feb;21(2):422–430. doi: 10.1038/ki.1982.40. [DOI] [PubMed] [Google Scholar]
  20. Hansson S., Jodal U., Lincoln K., Svanborg-Edén C. Untreated asymptomatic bacteriuria in girls: II--Effect of phenoxymethylpenicillin and erythromycin given for intercurrent infections. BMJ. 1989 Apr 1;298(6677):856–859. doi: 10.1136/bmj.298.6677.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hansson S., Jodal U., Norén L., Bjure J. Untreated bacteriuria in asymptomatic girls with renal scarring. Pediatrics. 1989 Dec;84(6):964–968. [PubMed] [Google Scholar]
  22. Harber M. J., Asscher A. W. Virulence of urinary pathogens. Kidney Int. 1985 Nov;28(5):717–721. doi: 10.1038/ki.1985.189. [DOI] [PubMed] [Google Scholar]
  23. Haycock G. B. Investigation of urinary tract infection. Arch Dis Child. 1986 Dec;61(12):1155–1158. doi: 10.1136/adc.61.12.1155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hellström M., Jodal U., Mårild S., Wettergren B. Ureteral dilatation in children with febrile urinary tract infection or bacteriuria. AJR Am J Roentgenol. 1987 Mar;148(3):483–486. doi: 10.2214/ajr.148.3.483. [DOI] [PubMed] [Google Scholar]
  25. Herzog L. W. Urinary tract infections and circumcision. A case-control study. Am J Dis Child. 1989 Mar;143(3):348–350. doi: 10.1001/archpedi.1989.02150150106026. [DOI] [PubMed] [Google Scholar]
  26. Hodson C. J., Maling T. M., McManamon P. J., Lewis M. G. The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol. 1975;Suppl 13:1–26. [PubMed] [Google Scholar]
  27. Jacobson S. H., Eklöf O., Eriksson C. G., Lins L. E., Tidgren B., Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ. 1989 Sep 16;299(6701):703–706. doi: 10.1136/bmj.299.6701.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Jodal U., Lindberg U., Lincoln K. Level diagnosis of symptomatic urinary tract infections in childhood. Acta Paediatr Scand. 1975 Mar;64(2):201–208. doi: 10.1111/j.1651-2227.1975.tb03822.x. [DOI] [PubMed] [Google Scholar]
  29. Jodal U., Winberg J. Management of children with unobstructed urinary tract infection. Pediatr Nephrol. 1987 Oct;1(4):647–656. doi: 10.1007/BF00853603. [DOI] [PubMed] [Google Scholar]
  30. Johnson C. E., DeBaz B. P., Shurin P. A., DeBartolomeo R. Renal ultrasound evaluation of urinary tract infections in children. Pediatrics. 1986 Nov;78(5):871–878. [PubMed] [Google Scholar]
  31. Khan A. J., Kumar K., Evans H. E. Single-dose gentamicin therapy of recurrent urinary tract infection in patients with normal urinary tracts. J Pediatr. 1987 Jan;110(1):131–135. doi: 10.1016/s0022-3476(87)80308-6. [DOI] [PubMed] [Google Scholar]
  32. Khan A. J., Kumar K., Evans H. E. Three-day antimicrobial therapy of urinary tract infection. J Pediatr. 1981 Dec;99(6):992–994. doi: 10.1016/s0022-3476(81)80040-6. [DOI] [PubMed] [Google Scholar]
  33. Koff S. A., Murtagh D. S. The uninhibited bladder in children: effect of treatment on recurrence of urinary infection and on vesicoureteral reflux resolution. J Urol. 1983 Dec;130(6):1138–1141. doi: 10.1016/s0022-5347(17)51725-5. [DOI] [PubMed] [Google Scholar]
  34. Lebowitz R. L. Pediatric uroradiology. Pediatr Clin North Am. 1985 Dec;32(6):1353–1362. doi: 10.1016/s0031-3955(16)34931-8. [DOI] [PubMed] [Google Scholar]
  35. Lebowitz R. L. The detection of vesicoureteral reflux in the child. Invest Radiol. 1986 Jul;21(7):519–531. doi: 10.1097/00004424-198607000-00003. [DOI] [PubMed] [Google Scholar]
  36. Lerner G. R., Fleischmann L. E., Perlmutter A. D. Reflux nephropathy. Pediatr Clin North Am. 1987 Jun;34(3):747–770. doi: 10.1016/s0031-3955(16)36266-6. [DOI] [PubMed] [Google Scholar]
  37. Lohr J. A. Use of routine urinalysis in making a presumptive diagnosis of urinary tract infection in children. Pediatr Infect Dis J. 1991 Sep;10(9):646–650. doi: 10.1097/00006454-199109000-00004. [DOI] [PubMed] [Google Scholar]
  38. Majd M. Radionuclide imaging in pediatrics. Pediatr Clin North Am. 1985 Dec;32(6):1559–1579. doi: 10.1016/s0031-3955(16)34942-2. [DOI] [PubMed] [Google Scholar]
  39. McCracken G. H., Jr, Ginsburg C. M., Namasonthi V., Petruska M. Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections. Pediatrics. 1981 Jun;67(6):796–801. [PubMed] [Google Scholar]
  40. Moffatt M., Embree J., Grimm P., Law B. Short-course antibiotic therapy for urinary tract infections in children. A methodological review of the literature. Am J Dis Child. 1988 Jan;142(1):57–61. doi: 10.1001/archpedi.1988.02150010067024. [DOI] [PubMed] [Google Scholar]
  41. Naylor G. R. A 16-month analysis of urinary tract infection in children. J Med Microbiol. 1984 Feb;17(1):31–36. doi: 10.1099/00222615-17-1-31. [DOI] [PubMed] [Google Scholar]
  42. Noe H. N. Screening for familial reflux: an update. Semin Urol. 1986 May;4(2):86–87. [PubMed] [Google Scholar]
  43. O'Regan S., Yazbeck S., Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. 1985 Mar;23(3):152–154. [PubMed] [Google Scholar]
  44. Ogra P. L., Faden H. S. Urinary tract infections in childhood: an update. J Pediatr. 1985 Jun;106(6):1023–1029. doi: 10.1016/s0022-3476(85)80263-8. [DOI] [PubMed] [Google Scholar]
  45. Parrott T. S. Cystitis and urethritis. Pediatr Rev. 1989 Jan;10(7):217–222. doi: 10.1542/pir.10-7-217. [DOI] [PubMed] [Google Scholar]
  46. Pecha B., Low D., O'Hanley P. Gal-Gal pili vaccines prevent pyelonephritis by piliated Escherichia coli in a murine model. Single-component Gal-Gal pili vaccines prevent pyelonephritis by homologous and heterologous piliated E. coli strains. J Clin Invest. 1989 Jun;83(6):2102–2108. doi: 10.1172/JCI114123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Poland R. L. The question of routine neonatal circumcision. N Engl J Med. 1990 May 3;322(18):1312–1315. doi: 10.1056/NEJM199005033221811. [DOI] [PubMed] [Google Scholar]
  48. Prentice A. Breast feeding increases concentrations of IgA in infants' urine. Arch Dis Child. 1987 Aug;62(8):792–795. doi: 10.1136/adc.62.8.792. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Reid G., Sobel J. D. Bacterial adherence in the pathogenesis of urinary tract infection: a review. Rev Infect Dis. 1987 May-Jun;9(3):470–487. doi: 10.1093/clinids/9.3.470. [DOI] [PubMed] [Google Scholar]
  50. Ring E., Zobel G. Urinary infection and malformations of urinary tract in infancy. Arch Dis Child. 1988 Jul;63(7):818–820. doi: 10.1136/adc.63.7.818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Schoen E. J. The status of circumcision of newborns. N Engl J Med. 1990 May 3;322(18):1308–1312. doi: 10.1056/NEJM199005033221810. [DOI] [PubMed] [Google Scholar]
  52. Shapiro E. D., Wald E. R. Single-dose amoxicillin treatment of urinary tract infections. J Pediatr. 1981 Dec;99(6):989–992. doi: 10.1016/s0022-3476(81)80039-x. [DOI] [PubMed] [Google Scholar]
  53. Shaw K. N., Hexter D., McGowan K. L., Schwartz J. S. Clinical evaluation of a rapid screening test for urinary tract infections in children. J Pediatr. 1991 May;118(5):733–736. doi: 10.1016/s0022-3476(05)80035-6. [DOI] [PubMed] [Google Scholar]
  54. Siegel S. R., Siegel B., Sokoloff B. Z., Kanter M. H. Urinary infection in infants and preschool children. Five-year follow-up. Am J Dis Child. 1980 Apr;134(4):369–372. doi: 10.1001/archpedi.1980.04490010027010. [DOI] [PubMed] [Google Scholar]
  55. Smellie J. M., Normand I. C. Urinary infections in children 1985. Postgrad Med J. 1985 Oct;61(720):895–905. doi: 10.1136/pgmj.61.720.895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Smellie J. M., Ransley P. G., Normand I. C., Prescod N., Edwards D. Development of new renal scars: a collaborative study. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1957–1960. doi: 10.1136/bmj.290.6486.1957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Smellie J. M. The DMSA scan and intravenous urography in the detection of renal scarring. Pediatr Nephrol. 1989 Jan;3(1):6–8. doi: 10.1007/BF00859615. [DOI] [PubMed] [Google Scholar]
  58. Sobel J. D. Pathogenesis of urinary tract infections. Host defenses. Infect Dis Clin North Am. 1987 Dec;1(4):751–772. [PubMed] [Google Scholar]
  59. Spencer J. R., Schaeffer A. J. Pediatric urinary tract infections. Urol Clin North Am. 1986 Nov;13(4):661–672. [PubMed] [Google Scholar]
  60. Stamey T. A., Condy M., Mihara G. Prophylactic efficacy of nitrofurantoin macrocrystals and trimethoprim-sulfamethoxazole in urinary infections. Biologic effects on the vaginal and rectal flora. N Engl J Med. 1977 Apr 7;296(14):780–783. doi: 10.1056/NEJM197704072961403. [DOI] [PubMed] [Google Scholar]
  61. Svanborg Edén C., Hausson S., Jodal U., Lidin-Janson G., Lincoln K., Linder H., Lomberg H., de Man P., Mårild S., Martinell J. Host-parasite interaction in the urinary tract. J Infect Dis. 1988 Mar;157(3):421–426. doi: 10.1093/infdis/157.3.421. [DOI] [PubMed] [Google Scholar]
  62. Svanborg Edén C., Linder H., de Man P., Mattsby-Baltzer I. Adherence, lipopolysaccharide and mucosal inflammation. Monogr Allergy. 1988;24:9–15. [PubMed] [Google Scholar]
  63. Svanborg Edén C., de Man P. Bacterial virulence in urinary tract infection. Infect Dis Clin North Am. 1987 Dec;1(4):731–750. [PubMed] [Google Scholar]
  64. Tappin D. M., Murphy A. V., Mocan H., Shaw R., Beattie T. J., McAllister T. A., MacKenzie J. R. A prospective study of children with first acute symptomatic E. coli urinary tract infection. Early 99mtechnetium dimercaptosuccinic acid scan appearances. Acta Paediatr Scand. 1989 Nov;78(6):923–929. doi: 10.1111/j.1651-2227.1989.tb11176.x. [DOI] [PubMed] [Google Scholar]
  65. Thelle T., Biskjaer N. Combined [99mTc]DMSA kidney scintigraphy and [131I]hippuran renography in children with urinary tract infections. Acta Paediatr Scand. 1985 Sep;74(5):720–725. doi: 10.1111/j.1651-2227.1985.tb10020.x. [DOI] [PubMed] [Google Scholar]
  66. Traisman E. S., Conway J. J., Traisman H. S., Yogev R., Firlit C., Shkolnik A., Weiss S. The localization of urinary tract infection with 99mTc glucoheptonate scintigraphy. Pediatr Radiol. 1986;16(5):403–406. doi: 10.1007/BF02386819. [DOI] [PubMed] [Google Scholar]
  67. Uehling D. T., Smith J., Meyer J., Bruskewitz R. Impact of an intermittent catheterization program on children with myelomeningocele. Pediatrics. 1985 Dec;76(6):892–895. [PubMed] [Google Scholar]
  68. Van den Abbeele A. D., Treves S. T., Lebowitz R. L., Bauer S., Davis R. T., Retik A., Colodny A. Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography. Pediatrics. 1987 Jan;79(1):147–153. [PubMed] [Google Scholar]
  69. Verber I. G., Strudley M. R., Meller S. T. 99mTc dimercaptosuccinic acid (DMSA) scan as first investigation of urinary tract infection. Arch Dis Child. 1988 Nov;63(11):1320–1325. doi: 10.1136/adc.63.11.1320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Verrier Jones K. Antimicrobial treatment for urinary tract infections. Arch Dis Child. 1990 Mar;65(3):327–330. doi: 10.1136/adc.65.3.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Verrier Jones K., Asscher W., Verrier Jones R., Mattholie K., Leach K., Thompson M. Renal functional changes in schoolgirls with covert asymptomatic bacteriuria. Contrib Nephrol. 1984;39:152–163. doi: 10.1159/000409245. [DOI] [PubMed] [Google Scholar]
  72. Viganò A., Dalla Villa A., Bianchi C., Gandini G., Gaboardi F., Principi N. Single-dose netilmicin therapy of complicated and uncomplicated lower urinary tract infections in children. Acta Paediatr Scand. 1985 Jul;74(4):584–588. doi: 10.1111/j.1651-2227.1985.tb11034.x. [DOI] [PubMed] [Google Scholar]
  73. Whitaker R. H., Sherwood T. Another look at diagnostic pathways in children with urinary tract infection. Br Med J (Clin Res Ed) 1984 Mar 17;288(6420):839–841. doi: 10.1136/bmj.288.6420.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Willi U., Treves S. Radionuclide voiding cystography. Urol Radiol. 1983;5(3):161-73, 175. doi: 10.1007/BF02926792. [DOI] [PubMed] [Google Scholar]
  75. Winberg J., Bollgren I., Källenius G., Möllby R., Svenson S. B. Clinical pyelonephritis and focal renal scarring. A selected review of pathogenesis, prevention, and prognosis. Pediatr Clin North Am. 1982 Aug;29(4):801–814. doi: 10.1016/s0031-3955(16)34213-4. [DOI] [PubMed] [Google Scholar]
  76. Wiswell T. E., Miller G. M., Gelston H. M., Jr, Jones S. K., Clemmings A. F. Effect of circumcision status on periurethral bacterial flora during the first year of life. J Pediatr. 1988 Sep;113(3):442–446. doi: 10.1016/s0022-3476(88)80625-5. [DOI] [PubMed] [Google Scholar]
  77. Wiswell T. E., Roscelli J. D. Corroborative evidence for the decreased incidence of urinary tract infections in circumcised male infants. Pediatrics. 1986 Jul;78(1):96–99. [PubMed] [Google Scholar]
  78. de Man P., Cläeson I., Johanson I. M., Jodal U., Svanborg Edén C. Bacterial attachment as a predictor of renal abnormalities in boys with urinary tract infection. J Pediatr. 1989 Dec;115(6):915–922. doi: 10.1016/s0022-3476(89)80742-5. [DOI] [PubMed] [Google Scholar]
  79. de Man P., Jodal U., Lincoln K., Edén C. S. Bacterial attachment and inflammation in the urinary tract. J Infect Dis. 1988 Jul;158(1):29–35. doi: 10.1093/infdis/158.1.29. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES