It is the most common
conditions of childhood. It
may involve urethra,
bladder, calyces and renal
It mainly includes:
Upper: it involves the ureters
Lower: it involves the
3-8% of girls and 1-2% of boys
develop a UTI during childhood.
Peak incidence is between 2 – 6
years of age.
Escherichia coli – 80% of cases
Gram negative enteric organisms
Other organisms include Proteus, pseudomonas,
klebsiella, staphylococcus aureus, haemophilus
Anatomic and physical factors
Structure of lower urinary tract accounts to
bacteriuria in females
- Short urethra in young girls (2cm) & in mature
women (4cm) provides pathway for organism to
Closure of urethra in the end of micturition may
lead to return of bacteria to bladder
- Longer male urethra and prostatic secretions
inhibit entry of pathogens in males
Incomplete emptying result from reflux ,
anatomic abnormalities, dysfunction of voiding
mechanism, extrinsic ureteral compression
caused by constipation etc leads to UTI.
Altered urine and bladder chemistry
An alkaline medium is favored by the pathogens.
A urine pH of about 5 hampers the bacterial
Throughout childhood, the risk of having a UTI is 2
percent for boys and 8 percent for girls.
Having an anomaly of the urinary tract increases the
risk of a UTI.
Boys who are younger than 6 months sold who are
not circumcised are at greater risk for a UTI than
circumcised boys the same age.
Cause : UVR, catheterization , postponement of
voiding, DM, low fliud intake etc
bacteria ascends the urethra
Lining of urinary tract becomes inflammed
Micturition reflex triggered
Urgency, frequency, burning hematuria, irritability,
failure to thrive, pyuria
-eliminate current infection
-Identify contributing factors and reduce risk of occurrence
-prevent systemic spread of infection
-preserve renal function
Antibiotic therapy based on:
identification of pathogen
history of antibiotic use
location of infection
Antimicrobial drugs (sometimes it will not be effective
due to resistance of organism)
penicillin, sulfonamide, cephalosporin, nitrofurantoin
For primary reflux or bladder neck obstruction,
surgical correction is needed to avoid recurrence.
Careful history taking regarding voiding habits, stooling
Caution the parents in suspected cases
Collect appropriate specimen
Checking diaper half hourly for straining, dripping of small
amounts of urine.
Explanation of procedure according to their age
Administer proper dosage of medications
Increase the fluid intake
Most UTIs are not serious, but some infections can
lead to serious problems, such as kidney infections.
Chronic kidney infections
Infections that recur or last a long time can cause
permanent damage, including kidney scars, poor
kidney growth, poor kidney function, high blood
pressure, and other problems.
Some acute kidney infections
infections that develop suddenly can be life
threatening, especially if the bacteria enter the
bloodstream, a condition called septicemia.
Simple hygienic habits should be followed
Practice habit of voiding soon as they feel the urge
Adolescent girls are advised to urinate soon after an
Reinforce parents and older children the importance
Circumcision in males
Plenty of oral fluids
Treatment of constipation, pinworms
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