Urinary tract infection resident survival guide (pediatrics)
Synonyms and keywords: Urinary tract infection in kids, UTI in kids, UTI in pediatrics, pedicatrics urinary tract infection

# Overview
Urinary tract infections (UTIs) are common in kids. UTIs occurs when bacteria (germs) get into the bladder (lower tract infection) or kidneys(upper tract). Abdominal pain and loin tenderness, with systemic features such as fever, anorexia, vomiting, lethargy and malaise are the signs of upper tract infection while lower abdominal or suprapubic pain, dysuria, urinary frequency and urgency are signs of lower tract infections. In younger children the typical signs are not clear and it is difficult to differentiation between upper and lower tract infection. Up to 8% of girls and 2% of boys will get a UTI by age 5.  Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition.

# Causes

## Life Threatening Causes
Urinary tract infections have two basic types, bladder infection and kidney infection. If the infection is in the bladder it is called cystitis and it causes pain and swelling in bladder. If the infection traveled up to the kidneys, it is called pyelonephritis which is serious and it may cause harm to the kidneys.

## Common Causes

## infection
- E.coli ,is the most common cause of UTI in children of all ages.
- Klebsiella, is the second common cause.
- Proteus
- Enterobacter and Enterococcus
- Citrobacter
- Staphylococcus saprophyticus
- Candida albicans.

### Mechanical
- vesicoureteral reflux , is the most common predisposing factor in recurrent UTI.
- urinary obstruction.

# FIRE: Focused Initial Rapid Evaluation
UTI should be considered in any infant or child presenting with fever without an identifiable source of infection, because it can be associated with acute mortality (i.e. urosepsis) and/or chronic medical problems like renal scarring, hypertension, and chronic renal insufficiency,that is why urinalysis and  urine culture should be done.The AAP (American Academy of pediatrics) recommendations for imaging after an initial febrile UTI were extensive and included renal and bladder ultrasound, voiding cystourethrography (VCUG) or radionuclide cystography in all children younger than two years of age 

# Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of UTI in children according to the AAP  guidelines.

# Treatment
Shown below is an algorithm summarizing the treatment of UTI in children according to the AAP  guidelines.
- The goals of treatment are:
Elimination of the acute infection.
Prevention of complications.
Reduction of renal damage.
- Elimination of the acute infection.
- Prevention of complications.
- Reduction of renal damage.

# Table1
Some Empiric Antimicrobial Agents for Oral Treatment of UTI.

# Table2
Empiric Antimicrobial Agents for Parenteral Treatment of UTI 

# Do's
- Immediate empirical antimicrobial.
- Diagnostic ultrasonography for kidney and bladder to detect anatomical abnormalities.
- Avoiding cystourethrogram VCUG, indicated if US(ultrasonography) shows Hydronephrosis, scarring, high grade Vesicoureteral Reflux.

# Don'ts
- Delay treatment while waiting for results of microscopy or culture, that would be harmful.
- Routine diagnostic imaging in all children with first infection.
- Giving prophylaxis antimicrobial to prevent febrile recurrent UTI.
- Surgical correction of minor functional abnormalities, moderate VUR.