convenient, inexpensive, and require little training
convenient, inexpensive, and require little training
approximately 30 percent of children with a normal CRP have pyelonephritis
Second- and third-generation cephalosporins (eg, cefprozil, cefpodoxime, cefixime, cefotaxime, ceftriaxone) and aminoglycosides (eg, gentamicin, amikacin) are appropriate first-line agents for empiric treatment of UTI in children. However, these drugs are not effective in treating Enterococcus and should not be used for patients in whom enterococcal UTI are suspected (eg, those with a urinary catheter in place, instrumentation of the urinary tract, or an anatomical abnormality). In such patients, amoxicillin or ampicillin should be added.
Urinary Tract Infections
Urinary Tract Infections Dr. Kalpana Malla MD Pediatrics Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
UTI• Definition:- Invasion & multiplication of micro- organisms in the urinary system – any component of the urinary tract including • Urethritis • Cystitis • Pyelonephritis
Physical examinations• Fecal mass• Signs of valvitis• Spine• Lower limb reflexes• Associated with UTI-Prune belly syndrome Anorectal anomalies
Localizing symptoms:Symptoms of urethritis:• Dysuria• Reluctance to void• Perineal discomfort• Vaginal irritation and erythema in girls• In older boys, urethral discharge• In adolescent girls associated with PID symptoms
Localizing symptoms:Features of cystitis:• Afebrile usually• Frequency• Enuresis• Dysuria• Reluctance to void
Localizing symptoms: Features of pyelonephritis: • Fever and systemic signs • Older children – Flank pain or abdominal pain • Younger children – Fever, irritability, vomiting, poor feeding
LABORATORY EVALUATIONMicroscopic exam• Bacteria: bacteriuria is the presence of any bacteria per hpf.• Gram stain
Routine Microscopic Examination• Color-Hazy• Smell- malodorous• White Blood Cells: pyuria is defined as ≥5 WBC/PHF in centrifused or ≥10 WBC/mm3 in an uncentrifuged sample• Bacteria: bacteriuria is the presence of any bacteria per hpf. - Gram stain
Routine Microscopic Examination• RBC >5 /HPF• RBC+WBC casts+• Albumin –Trace to +Urine C/S- gold standard - should be processed as soon as possible after collection
LABORATORY EVALUATION Urine culture• Midstream clean catch > 10⁵ colony forming units (girls) > 104 CFU (boys)• Catheterization 10⁵ CFU• Supra pubic aspiration any growth
LABORATORY EVALUATIONOther laboratory tests• Investigate the fever – CBC, CRP• Serum creatinine• Blood culture — Bacteremia occurs in 4-9 % of infants with UTI• Lumbar puncture — Infants <1 month of age with fever and a positive urinalysis; approximately 1 % of infants with UTI also have meningitis
Renal scans• DMSA renal scan – anatomy of kidney (Scarring)• DTPA renal scan – Excretory function ,filtration function of kidney• MAG 3 with lasix renal scan – Obstruction at the ureterovesical junction - quantitative information regarding kidney function and drainage , assesses the degree of blockage
Principle of management1. Treatment of acute infection2. Prevention of further infection3. Adequate investigation4. Arrangement of further treatment5. Follow up - Prevention of recurrence and long-term complications
MANAGEMENTIndication for hospitalize:• Age <2 months• Sepsis or potential bacteremia• Immunocompromised patient• Vomiting or inability to tolerate oral medication• Lack of adequate outpatient follow-up• Failure to respond to outpatient therapy
Choice & route of TreatmentDepends on – Age Severity of illnessChoice of agent: provide adequate coverage for E. coli.
ANTIBIOTIC THERAPY:• Newborn + Infants Inj ampicillin + Inj. Gentamycin-14 days• Older children:- Oral – Co-timoxazole cephalosprins Nalidixic acid amoxicillin-clavulanate• Parenteral therapy: Ampicillin or Third- or fourth- generation cephalosporins and aminoglycosides - first-line agents for empiric treatment of UTI in children.
MANAGEMENTANTIBIOTIC THERAPY• Duration of therapy: 7-14 days• Response to therapy: Clinical response Repeat urine culture
Indications for further investigations:1. Girls younger than 3 years with a first UTI2. Boys of any age with a first UTI3. Children of any age with a febrile UTI4. Children with recurrent UTI5. First UTI in a child of any age with a family history of renal disease, abnormal voiding pattern, poor growth, hypertension
Prevention1. General measures:-• Fluid intake• Complete and periodic voiding• Vioding at bed time• Perineal hyiene• Treatment of worms• Prevention of constipation• Avoid catheterization
Prevention• Early treatment of cong anomalies• Circumcision2. Low dose chemoprophylaxis - UTI until radiological evaluation is complete - Recurrent UTI - VUR grade I- III - Post operative-PUJ,VUR IV & V, PUV
Prevention- Chronic cystitis - Neurogenic ladderCommonly used drugs for prophylaxis:-• Co-trimoxazole-2mg/kg/d• Nalidixic acid-12.5mg/Kg/d• Nitrofurantoin -1mg/kg/d
Follow up1. Clinical- During the year following infection 1 year after starting prophylaxis height, Blood pressure –recorded2. Urine C/S- 3 monthly-infancy Fever & symptoms –older children3.RFT 4. Imaging –when neded
Thank youDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
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