Patient presented with urinary incontinence that started three days previously. Patient complained of the constant feeling of a full bladder. There was no pain, burning or stinging when passing water. Urine sample was taken and tested by urine analysis. Urine tested positive for blood and leukocytes. A 5 day course of broad spectrum antibiotic was prescribed.
Identified Learning need
To learn about urinary tract infections in children.
- To outline the pathological cause of urinary tract infections in children
- To briefly describe how recurrent UTIs are and indication of urinogenitary malformation
- To explain how UTIs are diagnosed
- What are the recommended methods of treating and preventing re-occurrence of UTIs?
Information Sources Used
- NICE guidelines
- Uritest 10V urine reagent strips guidance leaflet
- Merk Manual
- (2007) British Medical Journal, 335(7671), 395-7 BMJ.
- Patient UK
Answers/ Information/ Learning Achieved
1. Urinary Tract Infections are common in children under the age of 16, affecting approximately 3.6% of boys and 11% of girls4. They are caused by bacteria, usually Escherichia Coli, entering the urethra and migrating up to the bladder and, in severe infections the kidneys. Girls are often found to be more susceptible to developing UTIs because of their short urethras and the proximity of the entrance to the urethra and the anus3.
Being at 10 year old female puts her in the group most at risk of developing a urinary infection.
2. UTIs can develop due to a number of reasons caused by 'retention of urine' but often there can be no underlying condition5. Frequent and re-occurring UTIS however can be an indication of an indication of a malformation of the urinary system. 50% of infants and 20-30% of children aged 16 and under that suffer from recurrent UTIs will have such malformations3.The NICE guidelines state that all children suffering recurrent UTIs should have an ultrasound examination within 6 weeks of the infection to check for malformation1. The most common structural abnormality is vesicoureteric reflux3. This condition affects the junction of the ureter and the bladder and causes urine to reflux up the ureter to the kidneys. Scarring of the kidneys from this refluxing has been linked to 'severe hypotension, proteinuria and renal failiure'1.
3. UTIs are first diagnosed by a detailed history taking. The most common symptoms in children are 'fever, vomiting and drowsiness'5, while older children may complain of pain while urinating, urinating more frequently and incontinence3. NICE also advises that more uncommon symptoms may include jaundice, heamaturia, and smelly or cloudy urine1. The easiest way for a GP to confirm this diagnosis is to dipstick test a sample to urine obtained from the child. A positive result for leukocytes, blood and nitrites indicates a bacterial infection although 'a negative nitrite result does not in itself prove that there is no significant bacteriuria'2. Caution is advised when using dipsticks as negative results can be obtained 'when urine has not been retained in the bladder long enough'2. The sex of the patient can also impact on the results. Females may test positive for leukocytes and blood because of specimen contamination with vaginal discharge and menstrual blood respectively2.
Patient presented complaining of feeling 'generally unwell' and with urinary incontinence. Patient had experienced a need to urinate increasingly frequently. Her urine sample tested positive for both blood and leukocytes.
4. Children presenting with UTIs are mostly commonly prescribed oral antibiotics. The length of the course varies depending on the site of the infection but is generally 3-10 days3. Re-occurrence of the infection can be prevented by addressing any urinary retention problems, encouraging children who have had a UTI to drink plenty of fluids and to provide children with easy access to clean toilets so that they do not have to retain urine1.
Patient was prescribed broad spectrum oral antibiotics to be taken twice daily for 5 days.
- from clinical log sheet