Urinary tract infection (UTI) is one of the most common infections in childhood and is seen as the second most frequent infection after upper respiratory tract infections. It refers to the infection of any part of the urinary system, including the kidneys, ureters, and bladder, primarily by microorganisms, especially bacteria.
If the infection is only in the bladder, it is called “cystitis,” and if it has also reached the kidney, it is called “pyelonephritis.” While it is more common in male infants, especially uncircumcised babies, in the first year of life, the frequency increases in girls in later ages. Generally, it is observed in 3-7% of girls under 5 years old and 1-2% of boys.
WHY IS URINARY TRACT INFECTION IMPORTANT IN CHILDREN?
Urinary tract infections (UTIs) in childhood are often recurrent and are frequently associated with an underlying urinary tract anomaly that facilitates UTI development. Moreover, it can lead to serious problems such as high blood pressure, pregnancy issues, and chronic kidney failure due to kidney damage. The risk of kidney damage is higher in cases of early-onset UTIs, delayed treatment, and recurrent UTIs. For these reasons, it is crucial to identify the first UTI, provide adequate and timely treatment, and monitor the condition appropriately.
HOW DOES URINARY TRACT INFECTION DEVELOP IN CHILDREN?
Under normal conditions, urine is sterile and contains no microorganisms. In children, the most common causative agent of UTI is bacteria, with Escherichia Coli (E. Coli) accounting for 80-90% of cases. Bacteria that have settled and multiplied around the anal and genital areas enter through the urethra, the urinary canal, reaching the bladder, and later the kidneys, where they multiply and cause infection. Less commonly, bacteria can enter the urinary tract through the bloodstream or direct invasion due to infections in adjacent organs.
FACTORS INCREASING THE RISK OF URINARY TRACT INFECTION IN CHILDREN
1. Newborns and infants, especially in the first months of life, are susceptible to UTIs due to their underdeveloped immune systems.
2. In girls, the shorter length of the urethra makes it easier for bacteria to reach the urinary tract, increasing the susceptibility to UTIs.
3. Uncircumcised male infants, especially in the first year of life, may experience bacterial growth under the foreskin, leading to urinary tract infections.
4. Structural abnormalities in the urinary system, such as vesicoureteral reflux (VUR), where urine leaks from the bladder to the kidneys, facilitate UTI development. Any kidney abnormalities detected with prenatal ultrasonography should be closely monitored after birth.
5. Voiding disorders affecting bladder emptying or children who withhold urine can create conditions favorable for UTIs. Constipation, which impedes bladder emptying due to pressure from the intestines, is also a contributing factor.
SYMPTOMS OF URINARY TRACT INFECTION
In children under two years old, the symptoms are not specific to UTIs. Every baby with a high fever should be investigated for a UTI. Infrequent urination, crying during urination, inability to direct the urine stream in male infants, and foul-smelling urine are warning signs. Additionally, more general changes in the baby’s overall condition, such as prolonged jaundice, tendency to sleep, decreased activity, crying, fussiness, restlessness, poor appetite, feeding difficulties, diarrhea, vomiting, and failure to gain weight, may indicate UTI.
DIAGNOSIS OF URINARY TRACT INFECTION
The presence of white blood cells and bacteria in urine analysis suggests a UTI. The definitive diagnosis is made when bacteria grow in the urine culture. In older children, midstream urine samples are collected by discarding the initial and final portions of urine. For infants and children unable to communicate, a urine sample can be obtained using a urine bag. In certain cases, urine can be collected through catheterization or needle aspiration. Immediate delivery of urine samples to the laboratory minimizes the risk of contamination, ensuring more reliable results.
TREATMENT AND MONITORING OF URINARY TRACT INFECTION
Urinary tract infection is treated with an appropriate antibiotic for 7-14 days. In addition to treating UTI, it is crucial to investigate at-risk patients using various imaging techniques and apply preventive measures to avoid new infections. The most common method for research purposes is kidney ultrasound. Voiding cystourethrography, where a catheter is placed into the bladder to obtain X-ray images, may be performed to detect VUR. Nuclear medicine studies can be used to assess kidney damage and function. Preventive measures include ensuring adequate fluid intake and hygiene, frequent bladder emptying, preventing constipation, correcting voiding disorders if present, and circumcision in male children. In selected cases, continuous prophylactic antibiotic therapy may be considered.
In conclusion, UTIs are a significant problem in childhood, and effective collaboration between families and healthcare providers is crucial. Prompt initiation of appropriate and timely treatment, along with necessary investigations and preventive measures for at-risk patients, can minimize the risk of kidney damage associated with UTIs.