Urinary tract infection (pediatrics): Clinical sciences

Urinary tract infection, or UTI for short, is a common bacterial infection in children that can involve any part of the urinary tract. In children, UTIs are usually caused by gastrointestinal flora, such as Escherichia coli, that ascend into the bladder or kidneys, causing cystitis, pyelonephritis, or even urosepsis. If not treated promptly, UTIs can result in long-term complications, such as renal scarring, hypertension, and chronic renal disease. The management of UTIs depends on the patient’s age; more specifically, whether they are less or more than 2 months old.

If a child presents with a chief concern suggesting a UTI, you should first perform an ABCDE assessment to determine whether the child is stable or unstable. If your patient is unstable, stabilize the airway, breathing, and circulation. Next, obtain IV access, administer IV fluids, and start broad-spectrum antibiotics. Finally, begin continuous vital sign monitoring, including blood pressure, heart rate, respiratory rate, and oxygen saturation. If needed, don’t forget to provide supplemental oxygen.

Okay, now let’s go back to the ABCDE assessment and take a look at stable patients. In this case, start by obtaining a focused history and physical exam. Next, assess the patient's age, which will guide the treatment!

First, let’s take a look at term infants of 2 months of age and younger. These patients typically present with vague systemic symptoms, like fever, fussiness, and lethargy. Additionally, caretakers may report poor oral intake or vomiting, and they may describe the baby’s urine as foul-smelling. Next, the physical exam typically reveals an ill-appearing, uncomfortable infant with a body temperature of 38 degrees Celsius or higher. The physical exam could also reveal tachycardia and suprapubic tenderness.