Child getting UTIs

[DNAP]

Our 8yo has been plagued with urinary infections since before she was 2, and is currently on her 3rd round of antibiotics in 2 weeks, for her now 28th culture proven infection. This particular one is a proteus infection, but she's had everything from klebsiella to multi resistant e-coli, and has been hospitalised a few times with pyelonephritis. Even when they are not as serious as this, they are still exhausting for her. She's now had 2 weeks of waking 6 or 7 times a night, severe incontinence, leaks foul smelling urine all the time, and is generally just miserable and very fed up with it all. If this antibiotic doesn't work, she'll have to have an IV antibiotic to clear it, which has happened a few times now. Does anyone else have a child with frequent UTIs? And how frequent is too frequent? Although she does have another health issue, the general medical consensus, is that they don't think it's related in any way, and that some kids are just prone to them. We just can't accept this, it seems insane that a young child can notch up 28 full blown UTIs, and nobody can help her or tell us why?!
Does this really seem reasonable or should we be kicking up more of a fuss than we already have?

There are a number of possibilities from what you describe; firstly the dipstick test for leukocytes is not specific for UTI alone, so very often children will test positive, but not actually have a uti. Was the dipstick positive for nitrites also? It is more likely to be a uti when nitrites are also positive, unless it is a bacteria like Enterococcus, which doesn't reduce nitrates. Either way, the culture would ultimately determine what, if anything has grown.

In that regard, labs follow a particular protocol on reporting of what they term, significant growth. Usually this requires growth of a known pathogenic organism, above a certain threshold, usually 104 or preferably 105. This is also combined with results of microscopy, which would directly look at white cell counts in the urine, which would of course, support the diagnosis. It is only once a doctor has this full picture, that they can confirm a diagnosis for UTI. Without this, it is indeed unlikely. However, if your child's urine infection is confined to the bladder, then it is possible that the urine sample was not held in the bladder sufficiently long enough, and 4 hours is usually considered the optimum incubation time to get a good growth. The other possibility, is a uti that is confined lower down to the urethra, which causes very similar symptoms, but would not have growth levels that would be seen in an incubated bladder!
It must be frustrating to have negatives, when your child is symptomatic, so hopefully you can get to the bottom of it soon.

Thanks DNAP for your reply. I can't remember if the doctor said the test was positive for Nitrites, only blood and the white blood cells. I will have to check that. Yes it is frustrating. She has never had a 'positive' culture even though she has had the symptoms. She was born with a duplex kidney so we have to be careful which is why we go straight to the doctor and usually get antibiotics. The antibiotics always work to resolve the symptoms so presumably she must have a UTI but with a low bacterial count? Previous cultures have only grown low numbers which we were told weren't really UTI''s. Confusing.

My son has grade 5 reflux, severe hydronephrosis and a large volume bladder that has been in retention of 2litres in the past. Hes now being treated by a vesciostomy, a sort of overflow hole in his stomach where the urine leaks out into a pad rather than backing up into the kidneys. He has had 40+ infections with countless admissions which only really came down after the vesciostomy was created last year.

His consultant usually only worries about nitrates on a dipstick, unless other symptoms such as v high temp are obv as leuctocytes (white blood cells) can easily be transferred from the skin. Keotones are possibly down to dehydration. And blood unless a large positive can come from minor irritation of the urethra. (I believe wiping a little harshly in girls can commonly cause this)

He has regular ultrasound scans, cystography and dmsa scans. I know that his emptying studies were normal at one point but regressed to being massively abnormal (these are not commonly repeated) his dmsa results have also greatly differed from scan to scan. Ultrasound is not great at showing a lot for him. Its a quick 2 monthly check to give a very general guide for his kidney health.
He also had an mri to check for tethered cord.

I would be pushing for more tests. 28 confirmed utis and requirement for iv drugs is too much. My son has proved to his team that the tests can change over time.

Is your daughter under the care of a nephrologist or urologist as they can have varying opinions on what is deemed un/acceptable.

My sons nephrologist was very keen that his kidney health wasnt compromised anymore and pushed for a lot of further testing. The urologist was more of the "it doesnt fit this box. I dont know if x surgery will fix it. See you next week when hes readmittted for more iv"

Sorry for the ramble but i really would be seeking further medical opinion and testing
Wishing you and your daughter the best

Looks like my dd has another infection
This is her 2nd within the last 4 weeks.
Honestly feels like she's never going to be ready for the dsma scan at this rate. The trimethoprim isn't working in my opinion.
Back to the doctors tomorrow but she's had several accidents today, one at school one on the way home and again when we got home. she's complaining of a bellyache too, I feel so helpless and sorry for her

Maybe see about getting her on a prophaylactic (everyday) antibiotic dose.
Im not sure if this is what you mean by thw trimithoprine not working but there are many others that are used as a small daily dose which would hopefully get her uti free long enough for the dmsa

Sorry that is what I meant she takes 2.5ml every night, I did mention about changing it at our last urology appointment but it was a different consultant to our regular one and she said to keep it the same. It's hard because we don't know the full extent to the damage to her kidney until the scan and that doesn't seem to be happening anytime soon. So far her kidney is scarred and slightly smaller but it worries me that it's going to get worse the more infections she has

I would phone your consultants secretary and say you would like it to be changed as shes obv become immune (not the right word) to it

That's what I think too. Il ring them tomorrow hopefully they will change it

Have you tried giving her basil water?
Google benefits of basil water and read about the amazing stuff this simple plant does.
Lots of recipes on there. I highly recommend the lemon and basil drink.
You can dip the rim of the glass in water, then sugar and make it into a special cocktail for her.
Basil is nature's disinfectant and is easy to grow or get from the supermarket. Fresh is best.
Use it on hubby to stave off kidney stones.
Bearberry is another one but check her age against recommendations last I saw it was over six. This little beauty does wonders.You can get it from amazon. Don't take it for prolonged periods but is great for an attack or when you get that first warning. I take it for about a week even after symptoms have died down. Better than cystopurin and those other disgusting powders containing potassium citrate.
I also find tea very beneficial as the tannins relaxed the spasms.