Recurrent Urinary Tract Infection (UTI) – Causes, Diagnosis, Treatment, Precautions
URINARY TRACT INFECTION (UTI)
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Last Updated : 1/2/2012
Kumud P Mehta
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What is a urinary tract infection (UTI)?
Urinary tract infection is bacterial infection of kidneys and urinary tract, which can recur again and again if not diagnosed early and treated effectively.

How does a child get a urinary infection?
Majority of urinary infections occur due to entry of bacteria through urinary opening i.e. urethra (tube connecting the bladder to the opening outside on the body) which ascends to bladder, ureters (tube connecting the bladder to the kidney) and then kidneys. Unhygienic conditions around the genital region, diapers, pin worms, not cleaning the area after passing stools or bacterial diarrhea are some of the predisposing factors. In newborns and very small infants, bacteria enter the kidneys from blood circulation - blood borne infection.

How will my doctor diagnose urinary infection in my child?
Whenever a child gets fever without cough/cold or any focus of infection or these is painful urination, pain is abdomen with vomiting, loss of appetite, not gaining weight, the doctor will suggest urine to be tested routinely and culture to detect the type of bacteria which has caused infection. A high index of suspicion is necessary.

What precautions do I have to take for my child with UTI?
Under doctor's advice, appropriate antibiotic is prescribed which is specific for the bacteria, which has caused the infection. This medicine should be given in the prescribed dose for 7 - 10 days. Child should be given extra fluids to increase the urine flow to wash out the bacteria. The urinary parts should be cleaned with plenty of water each time he/she passes urine to prevent recurrent infections.

My child has had many episodes of urinary infections. The doctor has started her on long term antibiotics. Is it necessary?
If UTI becomes recurrent i.e. 2 - 3 attacks within 6 months; long term drug therapy after the episode of infection is cleared by 7 - 10 days of antibiotic therapy helps in preventing further infections. It is important to remember that each urinary infection especially with fever can affect the kidneys and leave behind permanent scars.

How can I prevent my child from getting a urinary infection?
Strict aseptic precautions, treatment of thread worms, relief of constipation, changing of diapers frequently (or not using diapers) and cleaning the bottom, vulval region in girls and penile region after retracting the skin in boys with plenty of water, giving extra fluids are simple but important measures to prevent urinary infections.

Is urinary infection dangerous? What complications can occur?
Urinary tract infection can be dangerous if treated late or incompletely (because of late diagnosis) and if recurrences occur, or if there are underlying defects or diseases of kidneys which are undiagnosed. Permanent renal scars due to recurrent UTI lead to high BP, chronic renal failure (requiring kidney transplant), growth failure, anemia in adolescents and young adults and toxemia of pregnancy in women who had urinary infections in childhood.

My elder child suffered from frequent UTI. How do I take care that it doesn’t occur in the younger one?
If your elder child suffered from UTI, the younger one need not get UTI because it is not hereditary. All the measures, which are advised to prevent recurrence of UTI, can be started from infancy to prevent the first UTI.

Is it necessary to treat UTI in child?
Yes, it is mandatory to treat UTI in childhood, because if untreated your child may develop kidney damage.

Will my child have any problems as an adult if he has UTI in childhood?
Kidney damage or scars lead to high BP, renal failure, growth failure, anemia. In a girl, it may recur during menstrual cycles, after marriage and during pregnancy, which may lead to toxemia of pregnancy.

How often is a urine test required? Is there no other way to detect UTI?
Urine test especially culture is only way to diagnose UTI. It is better to repeat urine test after completing the course of antibiotics to ensure that UTI is cleared.

How do I collect urine in my child?
In a sterile bottle from laboratory after cleaning the urinary area with soap and water thoroughly you allow a few drops of urine to flow and take the mid-stream of urine directly in the bottle, seal and send to the lab within 1 hour. This is possible if child is above 3 – 4 years and co – operative. Pre-sterilized urine collection bags which can be fixed around urethral openings are available for younger children especially girls for sterile collection of urine for culture.

Any dietary precautions required?
No dietary precaution except plenty of fluid intake is advised for UTI.

What are the other investigations required?
As mentioned earlier a number of birth defects of kidneys especially obstruction to the flow of urine are associated with recurrent UTI. If investigations like ultrasonography of kidneys, urinary bladder are not done, these defects remain undiagnosed. Recurrent UTI in most cases (50 – 75%) are due to undiagnosed defects which require long term medicines and surgical treatment to relieve obstruction.

What is MCU? How is it done? Is it not dangerous?
MCU (Micturating cystourethrogram) is an investigation to detect defects of urinary tract especially in the urethra and the bladder. It is not dangerous if done by expert pediatric urologist/nephrologist with radiologist. A thin tube (catheter) is introduced in the bladder through urethra and small amount of radio-contrast dye is injected after which 2 – 3 X-rays are taken when the bladder is filled and when child passes urine.

What is a nuclear scan? How is it done? Why is it necessary?
Nuclear scan is an imaging technique in which a small and safe dose of radio active agent is injected intravenously and its presence detected in kidney and urinary tract by special computerized equipment in a specialized nuclear medicine department. It is a sophisticated, accurate and safe method of detecting scars on kidney, function of individual kidney, obstruction of kidney and many other conditions. It gives a lot of useful information about kidneys with safety.



Contributor Information and Disclosures

Kumud P Mehta
Consultant Pediatrician & Pediatric Nephrologist, Jaslok Hospital & Research Centre, Bai Jerbai Wadia Hospital for children, Mumbai,India


First Created : 1/2/2002
Last Updated : 1/2/2012

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