Urinary tract infection in uncircumcised infants

Urinary Tract Infection Care: An Analysis of Existing Research

Urinary tract infections are one of the most common acute diseases facing children in their first years of life, and for many of these children there can be complications that lead to long-term renal problems and higher risks for re-infection. Males are generally less at risk than females for developing urinary tract infections, and circumcision causes an even greater reduction in risk. Uncircumcised male infants that develop an early urinary tract infection are at a heightened risk of long-term complications, then, and quick and effective care of these cases is vital in preventing such complications from arising. As a part of developing a program of care, an analysis of current literature regarding infant urinary tract infections is needed in order to provide background understanding.

Schoen, E.; Colby, C. & Ray, G. (2000). "Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life." Pediatrics 105(4), pp. 789-93.

The design of this study was a retrospective analysis of all infants delivered at twelve Kaiser Permanente facilities in Northern California. Essentially, rates of initial urinary tract infection and repeated infections for all infants delivered in these care facilities over a two-year period (1996 and 1997) were tracked, and analyzed by comparing circumcised males to uncircumcised males. Urinary tract infections and repetitions in females were also tracked though the study does not make much explicit use of this information.

Approximately sixty-five percent of the male infants in the study were circumcised shortly after birth, providing a slightly larger experimental group than the uncircumcised male population in the study, which can be thought of as a control group. The results of the study showed that while males in general were far less likely to suffer from a urinary tract infection than were girls (with almost half the rate of incidence overall), circumcised males had a drastically reduced chance of suffering from even one urinary tract infection, let alone repeated occurrences. In fact, less than fourteen percent of all the urinary tract infections in the male infants in the study occurred in circumcised infants. This clearly suggests that uncircumcised males should be assessed regularly and receive attention quickly in order to treat and prevent initial urinary tract infections and repetitions.

Jantunen, M.; saxen, H.; salo, E, & Siitonen, a. (2002). "Recurrent Urinary Tract Infections in Infancy: Relapses or Reinfections?" Journal of infectious diseases 185, pp. 375-9.

The design of this study is similar to that of the last, in that it followed several patients over a specific time period (eighteen months in this case, or six months longer than in the previous study for each individual subject) and monitored the rate of reoccurrence of urinary tract infections. Subjects for this study were not simply an entire population of infants born at certain facilities, however, but rather the study consisted of seventeen infants who had all been diagnosed with a urinary tract infection caused by E. coli.

The limitation of subjects to those that had suffered from initial urinary tract infections brought on by strains of the E. coli bacteria was essential given the purpose of the study, which aimed at determining how repeated cases f urinary tract infections were caused. Specific strains of the bacteria were identified from each of the seventeen infants initially diagnosed with a urinary tract infection that were a part of the study, and these were compared to cultures taken from infant during subsequent infections. The results showed that each infant had at least one recurrent episode caused by the exact same strain of the bacteria, and that same-strain infections accounted for the vast majority of recurring infections. This suggests that infection occurs from pathogens still present in the body, and is therefore more effectively treated as a relapse then considering each case to be a separate infection.

Cohen, a.; Rivara, F.; Davis, R. & Christakis, D. (2005). "Compliance with guidelines for the medical care of first urinary tract infections in infants: A population-based study." Pediatrics 115(6), pp. 1474-8.

The objective of this study was to determine both current and best practices regarding the care of infants in their first year that suffered from urinary tract infections, and to make recommendations for care based on a comparison of these two sets of practices. The study's design consisted of a retrospective analysis of data compiled by the Washington State Medicaid, and the care of urinary tract infections diagnosed in the first year of life evidenced in this source was compared to established best practices by te American Academy of Pediatrics.