Urinary tract infections in children: Epidemiology and risk factors
- Nader Shaikh, MD
Nader Shaikh, MD
- Assistant Professor of Pediatrics
- University of Pittsburgh School of Medicine
- Alejandro Hoberman, MD
Alejandro Hoberman, MD
- Associate Professor of Pediatrics
- University of Pittsburgh School of Medicine
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
Urinary tract infection (UTI) is a common and important clinical problem in childhood. Upper UTIs (ie, acute pyelonephritis) may lead to renal scarring, hypertension, and end-stage renal disease. Although children with pyelonephritis tend to present with fever, it is often difficult on clinical grounds to distinguish cystitis from pyelonephritis, particularly in young children (those younger than two years) . Thus, we have defined UTI broadly here without attempting to distinguish cystitis from pyelonephritis. Acute cystitis in older children is discussed separately. (See "Acute cystitis: Clinical features and diagnosis in children older than two years and adolescents".)
The presence of risk factors for UTI and renal scarring in a child presenting with fever and/or urinary symptoms is helpful in guiding diagnostic testing and management. The epidemiology and risk factors for UTI and renal scarring in children will be reviewed here. Clinical features, diagnosis, and management of UTI, and UTI in newborns (younger than one month of age) are discussed separately. (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis" and "Urinary tract infections in children: Long-term management and prevention" and "Urinary tract infections in neonates".)
Knowledge of the epidemiology of UTI is important in the evaluation of a child with suspected UTI. (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis", section on 'Laboratory evaluation'.)
Prevalence — Awareness of the prevalence of UTI in various subgroups of children enables the clinician to grossly estimate the probability of infection in the patient (ie, the pretest probability) (table 1).
In young children with fever — The prevalence of UTI in children <2 years presenting with fever has been the subject of several large prospective studies and a meta-analysis [2-4]. Important points that emerged from these studies include:
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- Keren R, Shaikh N, Pohl H, et al. Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring. Pediatrics 2015; 136:e13.
- Carpenter MA, Hoberman A, Mattoo TK, et al. The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics 2013; 132:e34.
- Wiswell TE, Miller GM, Gelston HM Jr, et al. Effect of circumcision status on periurethral bacterial flora during the first year of life. J Pediatr 1988; 113:442.
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- Martinell J, Claesson I, Lidin-Janson G, Jodal U. Urinary infection, reflux and renal scarring in females continuously followed for 13-38 years. Pediatr Nephrol 1995; 9:131.
- Olbing H, Claësson I, Ebel KD, et al. Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch). J Urol 1992; 148:1653.
- Ditchfield MR, Summerville D, Grimwood K, et al. Time course of transient cortical scintigraphic defects associated with acute pyelonephritis. Pediatr Radiol 2002; 32:849.
- Goldraich NP, Goldraich IH. Followup of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study. J Urol 1992; 148:1688.
- Benador D, Benador N, Slosman D, et al. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet 1997; 349:17.
- Lin KY, Chiu NT, Chen MJ, et al. Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol 2003; 18:362.
- Ataei N, Madani A, Habibi R, Khorasani M. Evaluation of acute pyelonephritis with DMSA scans in children presenting after the age of 5 years. Pediatr Nephrol 2005; 20:1439.
- Pecile P, Miorin E, Romanello C, et al. Age-related renal parenchymal lesions in children with first febrile urinary tract infections. Pediatrics 2009; 124:23.
- Mattoo TK, Chesney RW, Greenfield SP, et al. Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. Clin J Am Soc Nephrol 2016; 11:54.
- Shaikh N, Mattoo TK, Keren R, et al. Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring. JAMA Pediatr 2016; 170:848.
- - In young children with fever
- - In older children
- HOST FACTORS
- Lack of circumcision
- Female infants
- Genetic factors
- Urinary obstruction
- Bladder and bowel dysfunction
- Vesicoureteral reflux
- Sexual activity
- Bladder catheterization
- BACTERIAL-HOST INTERACTIONS
- RISK FACTORS FOR RENAL SCARRING
- General risk factors
- Prediction of renal scarring after first UTI
- INFORMATION FOR PATIENTS