Urinary tract infections in infants and children older than one month: Clinical features and diagnosis
- 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 infections (UTI) are a common and important clinical problem in childhood. Upper urinary tract infections (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) . As a result, 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 clinical features and diagnosis of UTI in children will be discussed here. The epidemiology, risk factors, and management of UTI in children and UTI in newborns (younger than one month of age) are discussed separately. (See "Urinary tract infections in children: Epidemiology and risk factors" and "Urinary tract infections in infants and children older than one month: Acute management, imaging, and prognosis" and "Urinary tract infections in children: Long-term management and prevention" and "Urinary tract infections in neonates".)
Urinary tract infections (UTI) may present with nonspecific symptoms and signs, particularly in infants and young children.
Younger children — In a meta-analysis of the diagnostic accuracy of the symptoms and signs of UTI in children younger than two years, the following symptoms and signs were the most helpful in identifying children with UTI (table 1) :
●History of UTI (likelihood ratio [LR] 2.3)
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- CLINICAL PRESENTATION
- Younger children
- Older children
- CLINICAL EVALUATION
- Physical examination
- LABORATORY EVALUATION
- Urine sample
- - Decision to obtain
- - How to obtain
- Rapidly available tests
- - Dipstick analysis
- - Microscopic exam
- Urine culture
- Other laboratory tests
- DIAGNOSIS OF UTI
- Significant bacteriuria
- - False negatives
- DIFFERENTIAL DIAGNOSIS
- Asymptomatic bacteriuria
- Other considerations
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS