Question Title: Allie recurrent UTI

My daughter is 3 years old and has had 5 UTI's in the last 16 months.
Her last culture and sensativity showed her to have enterococcus and
was on a 14 day course of Macrodantin, 1tsp 4x/d for 7 days and 1tsp.
at bedtime for another 7 days. The last 3 UTI's have all been approxi-
mately within 3-4 weeks of each other. Within 4 hours of the onset of
symptoms with her most recent UTI, she had frank bleeding which lasted
for 3 days until not visably seen by the eye. Her C&S also showed to
have 2+ bacteria and 3+ blood. Her infections are accompanied by fever,
no greater than 101F, flank and back pain, urgency and frequency. An
ultrasound and VCUG have all come back within normal limits showing no
anatomical defects or difficulties with reflux. I should also add that
she is allergic to PCN. We were refered to a pediatric urologist who
suggested we give her a 6month trial of Septra DS, one tsp at bedtime.
Her urinalysis at the urologists office showed no blood or signs of in-
fection but was positive for a small amount of ketones. I am very con-
cerned about an enterococcal infection in an otherwise healthy 3 year
old child with progressive worsening of symptoms with each new infection.
I am concerned about future scarring of her kidneys, or long term effects
of being on prophylactic antibiotics for 6 months. The urologist did not
want any further testing at this time. Are there any other tests or
suggestions you could make as to why this type of infection and how best
to treat it. We have tried all conventional methods and treatments as
far as cranberry juice, increasing fluid intake, showers and not baths,
and I take care of hygiene and wiping, etc. I would appreciate any
further input or suggestions.
Thank you,
Julie

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We apologise for the previous post (an answer to a different question)
Dear Julie,
A urinary tract infection (UTI) is caused by bacteria that get into the bladder. UTI’s are not uncommon in children particularly in little girls. They tend to keep coming back and need to be evaluated.
Some children are prone to get UTI’s because of a tendency that runs in the family. The infections recur because the bacteria stick to the skin around the opening to the bladder (the urethra) in some people, and then get into the bladder. All UTI’s start as a bladder infection , and then may spread to the kidney.
Your doctor needed to order an ultrasound to go with the VCUG. This is a standard work-up for UTI’s in children and one that is proven to be the best means of identifying and following any problems. The ultrasound is a painless procedure which is done by passing a probe over the skin overlying the kidneys and bladder. The US tells us if both kidneys are present, if a kidney may be obstructed and if the bladder empties normally. the other test, a VCUG, which you have already had, involves putting a catheter into the bladder, filling it with dye and taking X-rays. This test tells us if urine goes back up into the kidneys(REFLUX). This test is important since reflux cannot be seen on ultrasound. However , passing the catheter may cause momentary pain or a strong urge to urinate. There is usually no long term complications of either test.
Your child needs to have a culture after she has been treated to identify that the UTI is gone. Some children will continue to get UTI’s no matter what is done. Continue to drink plenty of fluids, go to the bathroom at least every 3-4 hours even if she doesn’t feel the need to void, and if constipation is present, it should be treated by changing to a high fiber diet. In the mean time continue the prophylactic antibiotics and talk to your doctor.

This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:UTI

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