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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

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Uti in children l.jpg

UTI in children

Sumathi Kannan


Significance l.jpg

Significance

  • Common condition

  • Accurate Diagnosis can be tricky

  • May lead to

    • Recurrence

    • Complications

      • Permanent renal damage


Background l.jpg

Background

  • Non-specific presentation

  • Acute morbidity

  • Recognition of co-morbidities


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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


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    Bacteriology

    • E.coli

    • Proteus (males)

    • Staphylococcus

    • Enterococci

    • Altered gut flora

    • Variation

      • Age at presentation

      • Sex distribution


    Incidence l.jpg

    Incidence


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    Morbidity

    • Varies with Age at presentation

    • Acute pyelonephritis

    • Structural abnormality

    • Sepsis/Systemic symptoms


    Presentation l.jpg

    Presentation

    • Febrile illness

    • Diarrhoea, vomiting

    • Non specific symptoms

    • Clinical suspicion

      • Age at presentation

      • Sex


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    Neonate/infant

    Fever

    Prolonged jaundice

    Poor feeding FTT

    Non specific symptoms

    Child

    Fever

    Urinary symptoms

    Abdominal pain

    Presentation


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    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


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    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


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    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


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    Differentialdiagnosis

    • Any febrile illness

    • Vulval irritation

    • Thread worms

    • Constipation

    • Structural abnormality

    • Sexual abuse


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    Management

    • Antimicrobial treatment

      • Duration

      • Prophylaxis

    • Follow up

      • Imaging

    • Referral criteria

    • Recurrent UTI

    • Prevention of complications


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    Antibiotics

    • Trimethoprim

      • 10-20% resistant

    • Nitrofurantoin

    • Cefalexin

      • disrupt gut flora

      • cause vaginal thrush

    • Avoid –Quinolones/ amoxicillin

      • 50% resistantto amoxicillin

      • Quinolones -arthropathy

    • Duration

    • Prophylaxis


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    Imaging

    • USS

    • MCUG

    • DMSA

    • RCPCH guidelines


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    Urgent

    Outflow obstruction

    Recent instrumentation

    Definite

    Diagnosis in doubt

    Structural abnormality

    Less than 5 years

    Recurrent UTI

    Failure to respond

    When to refer?


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    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


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    Thank you


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