1 / 18

Urinary tract infections in children What investigations?

Urinary tract infections in children What investigations?. Yves Heloury FRACS, Pediatric Urology. UTI- General considerations. 3 determinants in pediatrics Age Sex F ever UTI: 2 different situations Infants and young children with febrile UTI Toilet trained girls with afebrile UTI.

lucas-gilliam
Download Presentation

Urinary tract infections in children What investigations?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Urinary tract infections in childrenWhat investigations? Yves Heloury FRACS, Pediatric Urology

  2. UTI- General considerations • 3 determinants in pediatrics • Age • Sex • Fever • UTI: 2 different situations • Infants and young children with febrile UTI • Toilet trained girls with afebrile UTI 2

  3. UTI- General considerations 3

  4. UTI- General considerations • UTI: 3 steps • Diagnosis of UTI • Pyuria > 10 WBCs per μL • Bacteriuria > 105 CFU per ml • Treatment • Etiology and 4

  5. UTI- General considerations • Precise diagnosis • Treatment of children WITH UTI • Limited investigations • Focused more on function than on anatomy • Kidneys +++ • Bladder 5

  6. UTI- Children under 2 years • Guidelines AAP: Pediatrics 2011 http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330 • Infants and young children (2 to 24 months) • Fever > 38 • In a child with fever and no other clinical source of infection, the risk of UTI is 5% 6

  7. UTI- Children under 2 years (Guidelines AAP) Infant with fever UTI 5% Poor clinical tolerance Good clinical tolerance + SPA or catheterization Bag or Dipstick + - Antibiotherapy No UTI 7

  8. UTI- Guidelines AAP • Treatment • Oral antibiotherapy, except toxic child, digestive trouble • Duration: 7 to 14 days • After, no antibioprophylaxis if ultrasound normal • UTI in boys: discuss circumcision 9

  9. UTI- Guidelines AAP Investigations • Clinical examination • Abdomen (kidneys, bladder) • Genitalia • Sacrum 10

  10. UTI- Guidelines AAP Renal US • systematic except if high quality prenatal US at the third trimester • Why: detect dilatation ureters or pelvis; size of kidneys; renal abcess • When: not as emergency, except no clinical improvement after 2 days of ATB US abnormal in 15% but action in only 2% 11

  11. UTI- Guidelines AAP • First pyelonephritis • No other investigation, except dilatation of ureter and/or pelvis • Recurrent UTI (10%) • DMSA nuclear medicine • Scarring • 4 to 6 months after UTI • MCUG (VUR, Bladder, urethra) 12

  12. UTI in young children- Take home messages • Diagnosis is difficult • First UTI: ultrasound • Recurrences: DMSA and MCUG • Early treatment decreases scarring • Renal alterations are for a large part related to prenatal dysplasia 13

  13. UTI in older children • General considerations • Girls > 5 years • Cystitis with voiding disorders and/or constipation • Can be associated with episodes of pyelonephritis • Urinalysis only if pain • No urinalysis nor antibiotics for abnormal • color • odor 14

  14. UTI in older children • Clinical investigation • Previous history: toilet training, sexual abuse • Bladder function: fluid intake, dryness, diary • Bowell function: diet, soiling, consistency of poos • Abdomen, genitalia, sacrum • Neurological evaluation: Feet (tethered cord) 15

  15. UTI in older children • Paraclinic investigations • 1 or 2 cystitis: nothing • Recurrent cystitis • Uroflowmetry • Renal and bladder US • kidneys • pre and postvoiding volume • constipation • If associated pyelonephritis: DMSA nuclear medicine 16

  16. UTI in older children 17

  17. UTI in older children • Management • Bowell management: diet, fluid, movicol • Bladder management: urotherapy to improve bladder emptying (relaxation of pelvic floor, position on the toilets, double voiding) • Cranberry juice? • Medications • Antibiotics for symptomatic UTI • No long term antibioprophylaxis • Alpha blockers (bladder emptying) 18

  18. UTI in toilet trained children- Take home messages • Cystitis mainly related to constipation and poor bladder emptying • Investigation and management: bowel and bladder • Conservative management as long as the upper urinary tract is normal • Management of familial anxiety 19

More Related