Urinary tract infections in the infant

Abstract

Urinary tract infection (UTI) in an infant may be the first indication of an underlying renal disorder. Early recognition and initiation of adequate therapy for UTI is important to reduce the risk of long-term renal scarring. Ampicillin and gentamicin are traditionally the empiric treatment of choice; however, local antibiotic resistance patterns should be considered. Maternal antibiotics during pregnancy also increase the risk of resistant pathogens during neonatal UTI. Long-term management after the first UTI in infants remains controversial because of lack of specific studies in this age group and the risk-benefit issues for antibiotic prophylaxis between reduced recurrent disease and emergent antibiotic resistance.

Keywords: Antibiotic resistance; Escherichia coli; Infants; Renal imaging; Urinary tract infection; Vesicoureteral reflux.

Fig. 1

Ultrasound appearance of neonatal hydronephrosis. (A) Right kidney in an infant showing normal structures. (B) Left kidney in the same infant with edematous swollen slightly hyperechoic right kidney. (Courtesy of Dr T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands.)

Fig. 2

Grade III vesicoureteric reflux during micturition: reflux into the ureter and the calices with mild dilatation. (Courtesy of Dr Adriana Dubbeldam, Belgium. Available at: www.radiopedia.org.)