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UTI in children. Sumathi Kannan. Significance. Common condition Accurate Diagnosis can be tricky May lead to Recurrence Complications Permanent renal damage. Background. Non-specific presentation Acute morbidity Recognition of co-morbidities. Pathophysiology. Ascending in origin

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uti in children

UTI in children

Sumathi Kannan

significance
Significance
  • Common condition
  • Accurate Diagnosis can be tricky
  • May lead to
    • Recurrence
    • Complications
      • Permanent renal damage
background
Background
  • Non-specific presentation
  • Acute morbidity
  • Recognition of co-morbidities
pathophysiology
Pathophysiology
  • Ascending in origin
  • Urine in proximal urethra sterile
    • Contamination by periurethral flora
  • Risk factors
      • Sex
      • Constipation
      • Uncircumcised males
  • Factors predisposing to infection
      • Turbulent flow
      • Impaired bladder defence mechanisms
bacteriology
Bacteriology
  • E.coli
  • Proteus (males)
  • Staphylococcus
  • Enterococci
  • Altered gut flora
  • Variation
    • Age at presentation
    • Sex distribution
morbidity
Morbidity
  • Varies with Age at presentation
  • Acute pyelonephritis
  • Structural abnormality
  • Sepsis/Systemic symptoms
presentation
Presentation
  • Febrile illness
  • Diarrhoea, vomiting
  • Non specific symptoms
  • Clinical suspicion
    • Age at presentation
    • Sex
presentation9
Neonate/infant

Fever

Prolonged jaundice

Poor feeding FTT

Non specific symptoms

Child

Fever

Urinary symptoms

Abdominal pain

Presentation
investigations
Specimen Collection

BAG

clean catch

Storage

Transfer within 30 minutes of collection

Refrigerated at 4°c

Stored at 4°c for 48 h

is suitable for culture, not for microscopy

Bed side Detection

Dipstick

Microscopy

Laboratory

Culture

Imaging

USS

MCUG

DMSA

Investigations
investigations11
Investigations
  • Nitrite test
    • Clinically probable (suggestive symptoms and signs):
      • Positive test confirms UTI (predictive value 100%)
    • Clinically unlikely
      • A negative test excludes UTI (predictive value ~ 100%)
  • LE test
    • Marker, less sensitive than microscopy.
    • Clinically unlikely (not suitable for screening)
      • Negative test excludes UTI (predictive value approaches 100%).
  • Blood and protein – non specific
follow up
Follow Up
  • Parental education
    • Prompt recognition
    • Immediate medical treatment
  • Antimicrobial Prophylaxis
  • Refer for secondary care
  • Imaging
    • Abnormal imaging - involve secondary care
    • Long term
      • Monitor BP and Renal functions
differential diagnosis
Differentialdiagnosis
  • Any febrile illness
  • Vulval irritation
  • Thread worms
  • Constipation
  • Structural abnormality
  • Sexual abuse
management
Management
  • Antimicrobial treatment
    • Duration
    • Prophylaxis
  • Follow up
    • Imaging
  • Referral criteria
  • Recurrent UTI
  • Prevention of complications
antibiotics
Antibiotics
  • Trimethoprim
    • 10-20% resistant
  • Nitrofurantoin
  • Cefalexin
    • disrupt gut flora
    • cause vaginal thrush
  • Avoid –Quinolones/ amoxicillin
    • 50% resistantto amoxicillin
    • Quinolones -arthropathy
  • Duration
  • Prophylaxis
imaging
Imaging
  • USS
  • MCUG
  • DMSA
  • RCPCH guidelines
when to refer
Urgent

Outflow obstruction

Recent instrumentation

Definite

Diagnosis in doubt

Structural abnormality

Less than 5 years

Recurrent UTI

Failure to respond

When to refer?
take home message
Take home message
  • Atypical Presentation in Children
    • High Index of Clinical suspicion
  • Early Detection
    • Always Dip stick Urine
    • Urine Culture Diagnostic
  • Prophylaxis
  • Follow up
    • Early Intervention prevents Renal scarring
ad