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Urinary tract infection

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== Causes ==
UTIs are often caused by ''Escherichia coli'' (E. coli) bacteria, to which the infant has no passive immunity. In infant girls UTIs generally originate in the colon, whereas in infant boys they originate from the external environment, strongly suggesting that for boys such infections are iatrogenic.<ref>Maskell, R. ''et al''. Urinary Pathogens in the Male. ''British Journal of Urology'', (1975) vol.47.</ref> Although ''E. coli '' is one of the most common bacteria on the surface of human skin, strains found in hospitals tend to be particularly virulent.''E. coli'' that live in the intestinal tract cause urinary tract infections when allowed to get into the sterile urinary tract. Whether intact or circumcised, baby boys sitting in poopy diapers allows ''E. coli'' an opportunity to enter the urinary tract. And, of course, fiddling with the foreskin and introducing bacteria foreign to the baby's body or his urinary tract can cause UTI, too. The tight [[foreskin]] of the infant boy acts as a sphincter to allow urine to flow out, but prevents contaminants and pathogens from coming in.<ref>{{REFjournal |last=Fleiss |first=P.M. |author-link=Paul M. Fleiss |last2=Hodges |first2=F.M. |author2-link=Frederick M. Hodges |last3=Van Howe |first3=RS |author3-link=Robert Van Howe |url=http://www.cirp.org/library/disease/STD/fleiss3/ |title=Immunological functions of the human prepuce |journal=Sex Trans Infect |location=London |volume=74 |issue=5 |pages=364-367 |date=1998-10 |accessdate=2019-10-31}}</ref>
UTIs are usually associated with congenital abnormalities of the urinary tract.<ref>Ginsburg CM, McCracken GH. [http://www.cirp.org/library/disease/UTI/ginsburg/ Urinary tract infections in young infants]. ''Pediatrics'' 1982; 69:409-12.</ref><ref>Amato D, Garduno-Espinosa J. [http://www.cirp.org/library/disease/UTI/amato/ Circumcision of the newborn male and the risk of urinary tract infection during the first year: A meta-analysis]. ''Bol Med Infant Mex'' Volume 49, Number 10, October 1992, 652-658.</ref><ref>Schlager TA, Hendley JO, Dudley SM, Hayden GF, Lohr JA. Explanation for false-positive urine cultures obtained by bag technique. ''Arch Pediatr Adolesc Med'' 1995;149:170-3.</ref> The term ''vesicoureteral [ureterovesical] reflux'' refers to backflow of urine from the bladder to the ureters or kidneys. ''Ureteropelvic obstruction'' is a blockage or narrowing of part of the urinary tract. These kinds of congenital abnormalities are known to be the root cause of most UTI, as they may allow pathogens to flow upstream within the urinary tract.
=== UTIs in boys ===
In infant boys, UTIs originate from the external environment, strongly suggesting that these infections are iatrogenically caused.<ref>Maskell, R. ''et al''. Urinary Pathogens in the Male. ''British Journal of Urology'', (1975) vol.47.</ref> Two interventions that put the male infant at immediate risk for UTIs are [[circumcision]], and [[forced retraction]] of the foreskin. These interventions tear away the synechia which binds the foreskin to the glans in male infants, thereby creating entry points for ''E. coli '' bacteria,<ref>Winberg J ''et al''. [http://www.cirp.org/library/disease/UTI/winberg-bollgren/ The Prepuce: A Mistake of Nature?] ''Lancet'' 1989, pp.598-99.</ref> which binds to the glans penis of the infant.<ref>Cunningham N. [http://www.cirp.org/library/disease/UTI/cunningham/ Circumcision and urinary tract infections]. (letter) ''Pediatrics'' 1986; 77(2):267.</ref> Urinary tract infections (UTI) are a complication of circumcision.<ref>Smith RM. [http://www.cirp.org/library/disease/UTI/smith1916/ Recent contributions to the study of pyelitis in infancy]. ''Am J Dis Child'' 1916;XII:235-43.</ref><ref>Cohen, H. ''et al.'' [http://www.cirp.org/library/disease/UTI/cohen/ Postcircumcision Urinary Tract Infection]. ''Clinical Pediatrics'' (1992), pp. 322-4.</ref><ref>Goldman M, Barr J, Bistritzer T, Aladjem M. [http://www.cirp.org/library/disease/UTI/goldman/ Urinary tract infection following ritual jewish circumcision]. ''Israel Journal of Medical Sciences'' 1996;32(11),1098-102.</ref><ref>Prais D. Shoov-Furman R, Amir J. Is circumcision a risk factor for neonatal urinary tract infections? ''Arch Dis Child'' Published Online First: 6 October 2008. doi:10.1136/adc.2008.144063 [http://adc.bmj.com/cgi/content/abstract/adc.2008.144063v1 Abstract]</ref>
== Treatment ==
The most common way of relieving a urinary tract infection is the administration of anti-biotics,<ref name="ginsburg uti">Ginsburg CM, McCracken, Jr. GH. [http://www.cirp.org/library/disease/UTI/ginsburg/ Urinary tract infections in young infants]. ''Pediatrics'' 1982;69(4):409-412.</ref> if the infection does not clear up on its own.
== Recurrent UTI ==
== Prevention ==
Studies show fairly conclusively that UTIs can be easily prevented. Hospital-borne strains of ''E. coli '' remain the cause of the majority of UTIs, and infection can be resisted by taking certain measures to enhance the immunity of the infant to such pathogens.
=== Breastfeeding ===
=== Rooming in ===
Rooming-in permits colonization of the infant's skin and mucosa with the mother's own bacteria. The prepuce and other skin and mucosa of the infant should be specifically brought into contact with the mother's own skin to pass along her flora and initiate the child's natural immunity.<ref>Gothefors L, Olling S, Winberg J. Breast feeding and biological properties of faecal ''E. coli '' strains. ''Acta Paediatr Scand'' 1975;64(6):807-12.</ref><ref>Winberg J ''et al.'' [http://www.cirp.org/library/disease/UTI/winberg-bollgren/ The Prepuce: A Mistake of Nature?] ''Lancet'' 1989, pp.598-99.</ref>
=== Non-intervention ===
Prevention of UTI is not regarded as a reason to circumcise a boy.
 
{{SEEALSO}}
 
* [[The protective and hygienic function of the foreskin]]
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