Urinary Tract Infection

Overview

Bacteria are not usually seen in the urine. Urine is a byproduct of our kidneys' filtering system. Urine is produced when your kidneys eliminate waste products and excess water from your blood. Urine normally passes through your urinary system uncontaminated. Bacteria, on the other hand, can enter the urinary system from outside the body, producing infections and inflammation. This is an infection of the urinary system (UTI).

UTIs are frequent conditions that occur when bacteria enter the urethra and infect the urinary system, usually through the skin or rectum. Infections can affect several areas of the urinary tract, but the most frequent is a bladder infection (cystitis). Another kind of UTI is kidney infection (pyelonephritis). They are less prevalent than bladder infections, but they are more dangerous.

It can be difficult to tell whether your child has a UTI, as the symptoms can be vague and young children can't easily communicate how they feel. General signs that may suggest your child is unwell include: fever, vomiting, lethargy, irritability, poor feeding, not gaining weight properly in very young children. More specific signs that your child may have a UTI including pain or a burning sensation when peeing, needing to pee frequently, unpleasant-smelling pee, blood in their pee, and cloudy pee.

In a female child, symptoms alone can be used to make a diagnosis. Diagnosis might be challenging in persons with unclear symptoms since bacteria can be present without an infection. A urine culture may be effective in difficult conditions or if therapy fails.

UTIs are treated with a short course of oral antibiotics in uncomplicated instances. Most childhood UTIs clear up within 24 to 48 hours of treatment with antibiotics and won't cause any long-term problems.

In many cases, treatment involves your child taking a course of antibiotic tablets at home. As a precaution, babies under three months old and children with more severe symptoms are usually admitted to the hospital for a few days to receive antibiotics directly into a vein (intravenous antibiotics). If symptoms do not improve within two to three days, more diagnostic testing may be required. 

 

Structures of Urinary System

The kidneys, ureters, urinary bladder, and urethra comprise the urinary system. The kidneys produce urine and are responsible for the urinary system's other processes. The ureters transport urine from the kidneys to the urinary bladder, which serves as temporary storage for the pee. The urethra is a tubular tube that transports urine from the urinary bladder to the outer environment.

• The kidneys: They are the urinary system's major organs. The kidneys are the organs responsible for filtering the blood, removing wastes, and excreting wastes in the urine. They are the organs that execute urinary system tasks. The other components are support structures that help the body excrete urine.

 

• Ureter: Each ureter is a tiny, tube that transports urine from the renal pelvis to the urinary bladder. It descends from the renal pelvis and travels down the posterior abdominal wall below the parietal peritoneum before entering the urine bladder on the posterior inferior surface.

 

• Urinary bladder: The urinary bladder serves as a temporary reservoir for urine. It's in the pelvic cavity, below the parietal peritoneum and posterior to the symphysis pubis. The size and form of the urinary bladder change depending on how much urine it contains and how much pressure it gets from surrounding organs.

 

• Urethra: The final passageway for the flow of urine is the urethra, a thin-walled tube that conveys urine from the floor of the urinary bladder to the outside. The opening to the outside is the external urethral orifice.

 

Are Urinary Tract Infections (UTIs) Common?

Yes, Urinary tract infections are quite prevalent, affecting one out of every five women at some point in their lives. UTIs are more frequent in women, although they can also occur in males, elderly individuals, and children.

During childhood, 10% of people may get urinary tract infections. Urinary tract infections are most frequent in uncircumcised men under three months old, followed by girls under one year. However, estimates of frequency among kids vary greatly. A UTI was identified in two to twenty percent of children with fever ranging in age from newborn to two years. 

 

Risk Factors for UTI

Urinary tract infections may affect anybody, UTIs occur more often in girls, especially when toilet training begins. This is because the female urethra (the tube that removes urine from the body) is shorter and closer to the anus, where E. coli germs thrive. 

This higher risk might be attributed to inadequate bladder emptying. This can be caused by a number of medical issues, such as an enlarged prostate or a bladder prolapse (a condition where the bladder falls or slips out of its usual position).

If your child has frequent urinary tract infections,  the doctor may order tests to look for other health issues, such as diabetes or an abnormal urinary system, that might be contributing to infections. Children who have recurrent UTIs are often given low-dose antibiotics for a period of time to prevent the infection from recurrence. This careful approach to treating repeated UTIs is due to the possibility of antibiotic resistance and the development of additional infections, such as C. diff colitis. This is a relatively uncommon practice. 

 

UTI Causes

Uropathogenic E. coli from the gut causes 80–85 percent of community-acquired urinary tract infections, with Staphylococcus saprophyticus accounting for the remaining 5–10%. In rare cases, they may be caused by viral or fungal diseases.

Pathogens involved with healthcare-associated urinary tract infections (primarily connected with urinary catheterization) include E. coli, Klebsiella, Pseudomonas, the fungal pathogen Candida albicans, and Enterococcus, among others. However, some children may be more vulnerable to UTIs duo to:

1. Constipation: this can sometimes cause part of the large intestine to swell, which can put pressure on the bladder and prevent it emptying normally
2. Dysfunctional elimination syndrome: a relatively common childhood condition where a child "holds on" to their pee, even though they have the urge to pee.
3. Vesicoureteral reflux: an uncommon condition where urine leaks back up from the bladder into the ureters and kidneys; this occurs as a result of a problem with the valves in the ureters where they enter the bladder
4. Sex: Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus. As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora. Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections. Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.
5. Urinary catheters: Urinary catheterization raises the possibility of urinary tract infection. Bacteriuria (bacteria in the urine) is a daily risk of three to six percent, and preventive antibiotics are ineffective in reducing symptomatic infections. Catheterizing only when necessary, employing aseptic method for insertion, and maintaining clear closed drainage of the catheter can reduce the risk of an associated infection.
6. Others: A tendency to get bladder infections may run in families. This is thought to be hereditary in nature. Diabetes, being uncircumcised, and having a large prostate are all risk factors. People with spinal cord injuries are more likely to develop urinary tract infections, due in part to continuous catheter usage and in part to voiding dysfunction. It is the most prevalent source of infection and the most common reason for hospitalization in this population. 

 

Signs & Symptoms

A bladder infection is another name for a lower urinary tract infection. The most typical symptoms are burning with urination, the need to urinate often (or the desire to urinate) in the absence of vaginal discharge, and severe discomfort. These symptoms might range from moderate to severe and persist an average of six days in healthy women. There may be some pain above the pubic bone or in the lower back. In addition to the traditional symptoms of a lower urinary tract infection, people suffering from an upper urinary tract infection, or pyelonephritis, may have flank discomfort, fever, nausea, and vomiting. In rare cases, the urine may seem bloody or include visible pus.

A fever may be the only indication of a urinary tract infection (UTI) in young children. Many medical societies advocate a urine culture when girls under the age of two or uncircumcised boys under the age of a year have a fever due to the lack of more visible symptoms. Infants may have poor feeding habits, vomit, sleep more, or exhibit indications of jaundice. Urinary incontinence (lack of bladder control) may develop in older children. Sepsis and meningitis affect about 1 in 400 babies aged 1 to 3 months who have a UTI.

 

Diagnosis of UTI

The doctor will use the following tests to diagnose a urinary tract infection:

1. Urinalysis: This test will look for red blood cells, white blood cells, and bacteria in the urine. The presence of white and red blood cells in urine might suggest an infection.
2. Urine culture: A urine culture is used to determine the type of bacteria in the urine. This is an important test because it helps determine the appropriate treatment.

If the infection does not respond to therapy or if the child keep getting infections, the doctor may conduct the following tests to look for illness or injury in urinary tract:

1. Ultrasound: In this test, sound waves create an image of the internal organs. This test is done on top of abdomen skin, is painless and doesn’t typically need any preparation.
2. Cystoscopy: This test uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra.
3. CT scan: Another imaging test, a CT scan is a type of X-ray that takes cross sections of the body (like slices). This test is much more precise than typical X-rays.
4. Voiding cystourethrogram (VCUG): This is a type of X-ray of the urinary tract. A thin, flexible tube (catheter) is put in the tube that drains urine from the bladder to the outside of the body (the urethra). The bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.

 

Treatment/Management of UTI

A few days of antibiotic medications will typically treat urinary tract infection in children. Even if the child begins to feel better, it is critical that you continue to give your kid the medication according to the doctor's instructions. Skipping tablets may reduce the effectiveness of the medication.

The doctor may also advise you to give medication to numb your child's urinary tract and help him/her to feel better until the antibiotic takes effect. Don't be alarmed if your kid pee becomes light orange as a result of the medication.

In most cases, antibiotics are the first-line therapy for urinary tract infections. The medications given and the duration of treatment are determined by the medical condition and the type of bacteria discovered in the urine.

Simple infection:

Drugs commonly recommended for simple UTIs include:

• Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
• Fosfomycin (Monurol)
• Nitrofurantoin (Macrodantin, Macrobid)
• Cephalexin (Keflex)
• Ceftriaxone

Fluoroquinolone antibiotics, which include ciprofloxacin (Cipro), levofloxacin, and others, are not frequently advised for simple UTIs since the hazards exceed the benefits. In rare circumstances, such as a complex UTI or kidney infection, the doctor may prescribe a fluoroquinolone medication if no other treatment alternatives are available.

UTI symptoms often resolve within a few days after beginning medication. However, you may need to continue giving your child antibiotics for a week or longer. Take the whole course of antibiotics as directed.

If the child has an uncomplicated UTI and is generally healthy, the doctor may suggest a shorter course of therapy, such as taking an antibiotic for one to three days. However, whether this brief course of treatment is sufficient to treat infection is dependent on your specific symptoms and medical history.

Your doctor may also prescribe an analgesic (painkiller) that numbs your child's bladder and urethra to ease burning when urinating, but discomfort is normally resolved shortly after starting an antibiotic.

 

Frequent infections:

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

• Low-dose antibiotics, initially for six months but sometimes longer
• Self-diagnosis and treatment, if you stay in touch with your doctor

 

Severe infection:

For a severe UTI, you may need treatment with intravenous antibiotics in a hospital.

 

How do I know if the treatment isn’t working?

If the treatment isn't working, the symptoms will either remain the same, worsen, or develop new ones. If your child experiences fever, chills, lower stomach pain, nausea, or vomiting, contact your doctor. You should also see your doctor if your kid still gets a burning sensation when peeing after three days of taking the medication. 

 

Complications

Lower urinary tract infections seldom cause problems when treated early and correctly. A urinary tract infection, on the other hand, might have catastrophic consequences if left untreated.

Complications of a UTI may include:

• Recurrent infections, particularly in girls who have two or more UTIs in six months or four or more in a year.
• Acute or chronic kidney infection (pyelonephritis) caused by an untreated UTI can cause permanent kidney damage.
• Men with recurrent urethritis have a urethral narrowing (stricture), which was previously recognized with gonococcal urethritis.
• Sepsis is a potentially fatal infection consequence, especially if the infection spreads up your urinary tract to your kidneys.

 

Prevention of UTI

You can usually prevent a urinary tract infection (UTI) with lifestyle changes. These tips can include:

• Practicing good hygiene: UTIs may easily be avoided by adopting proper personal hygiene. This is especially true for girls. Because the urethra in women is significantly shorter than in males, E. coli bacteria may pass more easily from the rectum back into the body. It is suggested that you always wipe to your child from front to back after a bowel movement to avoid this. 

 

• Drinking plenty of fluids: Including more fluids, particularly water, in daily routine can aid in the removal of excess bacteria from the urinary system. It is advised that your child drink four to six glasses of water every day.

 

• Changing urination habits: Urination can aid in the removal of microorganisms from the body. Urine is a waste product, and when your child empty his bladder, he is eliminating that waste from the body. Urinating often can lower the risk of infection, particularly if there is a history of UTIs. Drinking plenty of fluids will help, but avoid drinks and foods that might irritate the bladder. 

 

• Changing your child's clothing: Avoiding wearing clothes that are too tight will help keep your kid dry and prevent bacteria from forming in your urinary system. You may also use cotton underwear. This will keep more moisture from accumulating around his urethra.

UTIs can also be treated with over-the-counter supplements. These are occasionally indicated as an additional method of prevention for patients who suffer frequent UTIs. Before beginning any supplements, consult with your healthcare physician to see whether these are a suitable fit or not.

 

Conclusion

A urinary tract infection (UTI) is an infection that affects the urinary system in some way. It is referred to as a bladder infection (cystitis) when it affects the lower urinary tract and a kidney infection when it affects the upper urinary tract (pyelonephritis).

Lower urinary tract infection symptoms include urination discomfort, frequent urination, and the desire to urinate despite having an empty bladder. In addition to the symptoms of a lower UTI, signs of a kidney infection include fever and flank discomfort. Urine may occasionally seem bloody. Symptoms in the very elderly and very young may be vague or non-specific.

The most frequent cause of infection is Escherichia coli, however other bacteria or fungi can also cause illness. Female anatomy, diabetes, obesity, VUR and family history are all risk factors. Despite the fact that sexual activity is a risk factor, UTIs are not categorized as sexually transmitted infections (STIs). 

If a kidney infection arises, it generally follows a bladder infection, although it can also be caused by a blood-borne infection. In young, healthy women, symptoms alone can be used to make a diagnosis. Diagnosis might be challenging in those with unclear symptoms since germs can be present without an infection. A urine culture may be effective in difficult conditions or if therapy fails.

UTIs are treated in simple instances with a brief course of antibiotics such as nitrofurantoin or trimethoprim/sulfamethoxazole. Many of the drugs used to treat this issue are becoming resistant. In more serious situations, a prolonged course of antibiotics or intravenous antibiotics may be required. If symptoms do not improve within two to three days, more diagnostic testing may be required. 

Antibiotics are typically unnecessary in people who have bacteria or white blood cells in their urine but no symptoms, with the exception of pregnant women. In people who get infections frequently, a brief course of antibiotics can be administered as soon as symptoms appear, or long-term antibiotics can be used to prevent infections.