pediatrics
Urinary Tract Infection (UTI) in Children
Key Points
UTIs in children are frequently associated with urinary tract abnormalities such as obstruction, neurogenic bladder, and ureteral duplication. The peak age of UTI is bimodal, one peak in infancy and the other peak usually at the time of toilet training for many children. E. colicauses most UTIs in all pediatric age groups; the remaining causes are usually gram-negative enterobacteria (eg,Klebsiella,P. mirabilis,P. aeruginosa); frequently implicated gram-positive organisms are enterococci and coagulase-negative staphylococci (eg,S. saprophyticus). Neonates and children < 2 years with nonspecific symptoms and signs (eg, poor feeding, diarrhea, failure to thrive, vomiting) may have a UTI; children > 2 years usually present with the symptoms and signs of cystitis or pyelonephritis. Antibiotics are initiated presumptively in all toxic-appearing children and in nontoxic children with evidence of positive leukocyte esterase nitrites, or pyuria. For children with high-grade vesicoureteral reflux (VUR), antibiotic prophylaxis is given until surgical correction is done; with lesser grades of VUR, the benefit of prophylactic antibiotics is unclear and close monitoring for recurrent UTI may be an acceptable management strategy for individual children. 