Pediatric Urinary Tract Infection Differential Diagnoses

  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 16, 2012
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of urinary tract infection (UTI) include the following:

  • Epididymitis
  • Orchitis
  • Prostatitis
  • Urethritis
  • Pregnancy
  • Urolithiasis
  • Vesicoureteral reflux

Adolescent girls are more likely to have vaginitis (35%) than UTI (17%). Adolescent girls who are diagnosed with cystitis frequently have a concurrent vaginitis.

Pregnancy must be considered in adolescent girls who present with symptoms of UTI and/or vaginitis and who are sexually active.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Donna J Fisher, MD  Assistant Professor of Pediatrics, Tufts University School of Medicine; Interim Chief, Division of Pediatric Infectious Diseases, Baystate Children's Hospital

Donna J Fisher, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Ann G Egland, MD Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center

Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Terrance K Egland, MD Director, Business Planning and Development, Bureau of Medicine and Surgery

Disclosure: Nothing to disclose.

Stanley Hellerstein, MD (Retired) Pediatric Nephrologist, Children's Mercy Hospital of Kansas City; (Retired) Ernest L Glasscock, MD Chair in Pediatric Research, Professor of Pediatrics, University of Missouri School of Medicine at Kansas City

Disclosure: Nothing to disclose.

David S Howes, MD Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Stephen L Thornton, MD Assistant Professor of Emergency Medicine, University of Kansas Hospital

Stephen L Thornton, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

References

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Application of low-risk criteria and approach for the febrile infant. A reasonable approach for treating febrile infants younger than 3 months who have a temperature of greater than 38°C.
Table 1. Urinalysis for Presumptive Diagnosis of Urinary Tract Infection*
Method Findings
Bright-field or phase-contrast microscopy of centrifuged urinary sedimentBacteria
Gram stain of uncentrifuged or centrifuged urinary sedimentBacteria
Nitrite and leukocyte esterase testPositive = UTI likely
Nitrite testPositive = UTI probable
Leukocyte esterase testPositive = Nonspecific
*Negative microscopic findings for bacteria do not rule out a UTI, nor do negative results of dipstick testing for nitrite and leukocyte esterase.
Table 2. Quantitative Urine Culture for the Diagnosis of Urinary Tract Infection*
Method Finding
Suprapubic aspirationIf a UTI is present, bacteria are likely to be proliferating in bladder urine, with growth of any organism except 2000-3000 CFU/mL coagulase-negative staphylococci.
Catheterization in a girl or midstream, clean-void collection in a circumcised boyFebrile infants and children with UTI usually have >50,000 CFU/mL of a single urinary pathogen; however, UTI may be present with 10,000-50,000 CFU/mL of a single organism.*
Midstream, clean-void collection in a girl or uncircumcised boyUTI is indicated when >100,000 CFU/mL of a single urinary pathogen is present in a symptomatic patient. Pyuria usually present. A UTI may be present with 10,000-50,000 CFU/mL of a single bacterium.*
Any method in a girl or boyIf the patient is asymptomatic, bacterial growth is usually >100,000 CFU/mL of the same organism on different days. If pyuria is absent, this result probably indicates colonization rather than infection.
*Patients with urinary frequency (ie, decreased bladder incubation time) are those most likely to have bacteria proliferating in the urinary bladder in the presence of low colony counts.
Table 3. Antibiotic Agents for Parenteral Treatment of a Urinary Tract Infection
Drug Dosage and Route Comment
Ceftriaxone50-75 mg/kg/day IV/IM as a single dose or divided q12hDo not use in infants < 6wk of age; parenteral antibiotic with long half-life; may displace bilirubin from albumin
Cefotaxime150 mg/kg/day IV/IM divided q6-8hSafe to use in infants < 6wk of age; used with ampicillin in infants aged 2-8wk
Ampicillin100 mg/kg/day IV/IM divided q8hUsed with gentamicin in neonates < 2wk of age; for enterococci and patients allergic to cephalosporins
GentamicinTerm neonates < 7 days: 3.5-5 mg/kg/dose IV q24h



Infants and children < 5y: 2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h



Children =5y: 2-2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h



Monitor blood levels and kidney function if therapy extends >48 h
Note: IM = intramuscular; IV = intravenous; q = every.
Table 4. Antibiotic Agents for the Oral Treatment of Urinary Tract Infection
Antibacterial Agent Daily Dosage
Sulfisoxazole120-150 mg/kg divided q4-6h
Sulfamethoxazole and trimethoprim6-12 mg/kg TMP, 30-60 mg/kg SMZ divided q12h
Amoxicillin and clavulanic acid20-40 mg/kg divided q8h
Cephalexin20-50 mg/kg divided q6h
Cefixime8 mg/kg divided q12-24h
Cefpodoxime10 mg/kg divided q12h
Nitrofurantoin*5-7 mg/kg divided q6h
*Nitrofurantoin may be used to treat lower UTIs. However, because of its limited tissue penetration, nitrofurantoin is not suitable for the treatment of kidney infection.
Table 5. Antibiotic Agents to Prevent Reinfection
Agent Single Daily Dose
Nitrofurantoin*1-2 mg/kg PO
Sulfamethoxazole and trimethoprim*1-2 mg/kg TMP, 5-10 mg/kg SMZ PO
Trimethoprim1-2 mg/kg PO
*Do not use nitrofurantoin or sulfa drugs in infants younger than 6 weeks. Reduced doses of an oral, first-generation cephalosporin, such as cephalexin at 10 mg/kg, may be used until the child reaches age 6 weeks. Ampicillin or amoxicillin are not recommended, because of the high incidence of resistant E coli.
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