Urinary tract infection (UTI) is defined as infection located in the lower tract (bladder or urethra) or in the upper tract (ureters or kidneys). The peak incidence of UTI observed in children occurs between 2 and 6 years of age, but can be observed at any age. The incidence of UTI in children also varies by gender: females have a 10% to 30% greater risk of developing a UTI; males have a 50% greater risk of developing a recurrent UTI; and during the newborn-age range only, male infants are at a greater risk of developing a UTI.
Etiologic factors associated with UTI in children include: 75% to 80% of bacterial infections are caused by Escherichia coli. Bacterial organisms occur more frequently than viral or fungal organisms which are more frequent in low-birth weight and preterm infants. The higher incidence in female children is attributed to the female child's anatomic differences from the male child (shorter urethra with an increased chance of contamination caused by the close proximity to the anus), other factors include: urinary stasis, poor hygiene practices, and external factors (i.e., Foley catheter, tight fitting diapers, exposure to bubble baths).
Diagnosis of UTI can be made by a urine culture from a clean-catch or a catheterized specimen. However, there is a high risk for contamination with clean-catch specimens. Lab result criteria for a UTI diagnosis: colony counts of 100,000 colonies in a clean-catch urine; and any urine culture greater than 5,000 colonies from urine obtained on a suprapubic puncture or catheterized specimen. Signs and symptoms of UTI in pediatric patients are age-related. For example, unique symptoms of UTI displayed by the infant: failure to thrive and fever; by the preschooler: anorexia and somnolence; by the school-ager: enuresis and personality changes; and those by the adolescent: fatigue and flank pain.
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