UTI in children

1. UTI in children Sumathi Kannan

2. Significance • Common condition • Accurate Diagnosis can be tricky • May lead to • Recurrence • Complications • Permanent renal damage

3. Background • Non-specific presentation • Acute morbidity • Recognition of co-morbidities

4. 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

5. Bacteriology • E.coli • Proteus (males) • Staphylococcus • Enterococci • Altered gut flora • Variation • Age at presentation • Sex distribution

6. Incidence

7. Morbidity • Varies with Age at presentation • Acute pyelonephritis • Structural abnormality • Sepsis/Systemic symptoms

8. Presentation • Febrile illness • Diarrhoea, vomiting • Non specific symptoms • Clinical suspicion • Age at presentation • Sex

9. Neonate/infant Fever Prolonged jaundice Poor feeding FTT Non specific symptoms Child Fever Urinary symptoms Abdominal pain Presentation

10. 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

11. 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

12. 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

13. Differentialdiagnosis • Any febrile illness • Vulval irritation • Thread worms • Constipation • Structural abnormality • Sexual abuse

14. Management • Antimicrobial treatment • Duration • Prophylaxis • Follow up • Imaging • Referral criteria • Recurrent UTI • Prevention of complications

15. Antibiotics • Trimethoprim • 10-20% resistant • Nitrofurantoin • Cefalexin • disrupt gut flora • cause vaginal thrush • Avoid –Quinolones/ amoxicillin • 50% resistantto amoxicillin • Quinolones -arthropathy • Duration • Prophylaxis

16. Imaging • USS • MCUG • DMSA • RCPCH guidelines

17. Urgent Outflow obstruction Recent instrumentation Definite Diagnosis in doubt Structural abnormality Less than 5 years Recurrent UTI Failure to respond When to refer?

18. 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

19. Thank you