Urinary Tract Infection In Children
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Urinary Tract Infection In Children. Dr. Alia Al-Ibrahim Consultant Pediatric Nephrology Clinical Assistant Professor. Contents: 1- Definition of UTI 2- Etiology & pathogenesis 3- Predisposing Factors 4- Clinical presentations 5-Investigations 6- Management 7- Complications

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Urinary Tract Infection In Children

Dr. Alia Al-Ibrahim

Consultant Pediatric Nephrology

Clinical Assistant Professor


Contents:

1- Definition of UTI

2- Etiology & pathogenesis

3- Predisposing Factors

4- Clinical presentations

5-Investigations

6- Management

7- Complications

8- Special problems in UTI


UTI in Children

Definition:

Presence of bacteria in urine along with symptoms of infection.

Incidence:

5% in Girls 1-2% in Boys

During the 1st yr of life more common in boys, after age of one more in girls

Etiology:

Most common infecting pathogen : Escherichia Coli 80% of UTI.

Other pathogens: - Staphylococcus & Streptococcus Species

- Enterobacteria ( Klebsiella, Proteus, pseudomonas)

- Occasionally Candida albicans


Route of infection:

Neonate: Hematogenous

Later : Ascension of bacteria into the Urinary tract.

Development of UTI depend on:

1- Virulence of the invading bacteria.

2- Susceptibility of the host.

Predisposing factors:

1- Conditions lead to urinary stasis : renal calculi, Obstructive Uropathy ,

VUR, & Voiding disorder.

2- Immune deficiency

3- Broad- spectrum antibiotics ( amoxicillin, cephalexin).

4- constipation

5- uncircumcised male


Clinical Presentation:

1- Upper UTI (Pyelonephritis).

2- Lower UTI ( Cystitis).

The history & clinical coarse varies with the patient’s age & specific diagnosis.


  • 0-2months: sepsis

  • 2mon-2yrs: unexplained fever

  • irritability, poor oral intake, abdominal pain, vomiting, loose

  • bowel movement.

  • voiding symptoms of cystitis

  • crying on urination

  • smelly urine

  • no fever or mild

  • 2yrs :

  • Pyelonephritis( fever, irritability, poor appetite, abdominal flank

  • pain back pain, voiding symptoms, tenderness in

  • costovertebral angle or flank.

  • cystitis : voiding symptoms ( urgency, frequency, hesitancy, dysuria,

  • urinary incontinence)

  • mild or no fever, Suprapubic or abdominal pain


  • Urine analysis & dipstick:High index of suspicion for UTI in febrile children particularly those with unexplained fever. Lasts for 2-3days;

  • > 5 WBC/ hpf in centrifuged fresh urine positive screening test.

  • >Bacteria in cent. & non cent. Or phase contrast suggestible of UTI.

  • >Pyuria, proteinuria & Hematuria may occur with or without UTI.

  • >Nitrite concentrations & leukocyte estrase

  • POSITIVE URINE CULTURE IS ESSENTIAL FOR DIAGNOSIS OF UTI.

  • Urine culture:

  • Suprapubic : any number of colonies.

  • IN-and- out catheterization: > 10³. E.COLI

  • Midstream clean-catch urine collection > 10,000

  • Single organism

  • 2 or more contamination. E.COLI

  • Blood culture :neonate & infant

  • Pyelonephritis: CBC: neutrophlic leukocytosis

  • high ESR

  • C-reactive protein. Proteus Pseudomonas

  • Distinction between upper & lower difficult in children


  • Management:

  • < 5 yrs:

  • With systemic signs:

  • 1- Iv antibiotics shift to oral after improvement , duration 10 -14 days.

  • 2- US , renal cortical scintigraphy ( DMSA) , MCUG.

  • No systemic signs:

  • 1- oral antibiotics for 7-10 days

  • US, MCUG( if indicated)

  • 5 yrs

  • Female: Female & Male with signs

  • 1- no signs : oral antibiotics Like < 5 yrs

  • Male:

  • 1- No signs: oral antibiotics

  • 2- US, MCUG


COMPLICATIONS:

1- VUR

2- Scarring

3- HTN

4- Renal insufficiency.

VUR

Normal DMSA

Acute Pyelonephritis

Scarring


Special problems

1-Reurrent UTI:

Two or more UTIs over a six –months period.

Causes: Inadequate treatment.

unrecognized site of bacterial persistence such as small infected

calculus or un recognized anatomic abnormality.

2-VUR:

Abnormal backwash of urine into ureter or kidney

Radiological evaluation VCUG, Isotope cystogrm


  • 3-Breakthrough UTI:

  • Caused by:

  • 1- change in the resistance pattern of organisms colonizing the

  • urethra.

  • 2- noncompliance.

  • 3- VUR

  • 4- Voiding dysfunction.

  • 4-Voiding dysfunction:

  • Detrusor instability & incomplete bladder emptying

  • Associated with daytime enuresis & constipation.

  • Increase risk of UTI & VUR.

  • RX: 1- Timed voiding

  • 2- Treatment of constipation.

  • 3- Prophylactic antibiotics.

  • 4- Anticholinergic medications.

  • 5-Asymptomatic bacteruria:

  • No need for antibiotics, low risk of scarring.


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