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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 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


  • Bacteriology l.jpg
    Bacteriology

    • E.coli

    • Proteus (males)

    • Staphylococcus

    • Enterococci

    • Altered gut flora

    • Variation

      • Age at presentation

      • Sex distribution



    Morbidity l.jpg
    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


    Investigations l.jpg

    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


    Follow up l.jpg
    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


    Management l.jpg
    Management

    • Antimicrobial treatment

      • Duration

      • Prophylaxis

    • Follow up

      • Imaging

    • Referral criteria

    • Recurrent UTI

    • Prevention of complications


    Antibiotics l.jpg
    Antibiotics

    • Trimethoprim

      • 10-20% resistant

    • Nitrofurantoin

    • Cefalexin

      • disrupt gut flora

      • cause vaginal thrush

    • Avoid –Quinolones/ amoxicillin

      • 50% resistantto amoxicillin

      • Quinolones -arthropathy

    • Duration

    • Prophylaxis


    Imaging l.jpg
    Imaging

    • USS

    • MCUG

    • DMSA

    • RCPCH guidelines


    When to refer l.jpg

    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 l.jpg
    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