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Urinary Tract Infection In Children

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

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  1. Urinary Tract Infection In Children Dr. Alia Al-Ibrahim Consultant Pediatric Nephrology Clinical Assistant Professor

  2. 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

  3. 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

  4. 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

  5. Clinical Presentation: 1- Upper UTI (Pyelonephritis). 2- Lower UTI ( Cystitis). The history & clinical coarse varies with the patient’s age & specific diagnosis.

  6. 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

  7. 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

  8. 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

  9. COMPLICATIONS: 1- VUR 2- Scarring 3- HTN 4- Renal insufficiency. VUR Normal DMSA Acute Pyelonephritis Scarring

  10. 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

  11. 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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