Approach to UTI in pediatrics. Risk factors for UTI. Type of UTI. and treatment

1. Urinary tract infection in children

2. Introduction

The urinary tract is a common site of infection in the
pediatric population.Unlike the generally benign course of
urinary tract infection (UTI) in the adult population.

UTI in the pediatric population is well recognized as a
cause of acute morbidity and chronic medical conditions,
such as hypertension and renal insufficiency in adulthood.

3. 
As a result, it is crucial to have a clear understanding of the
pathogenesis of UTI, risk factors, indications for diagnostic
tests, and the appropriate uses of antimicrobial agents in
the management of children with UTI.

4. 
The urinary tract (ie, kidney, ureter, bladder, and urethra) is a
closed, normally sterile space lined with mucosa composed of
epithelium known as transitional cells.

The main defense mechanism against UTI is constant
antegrade flow of urine from the kidneys to the bladder with
intermittent complete emptying of the bladder via the
urethra.

5. 
This washout effect of the urinary flow usually clears the
urinary tract of pathogens

The urine itself also has specific antimicrobial characteristics,
including low urine pH, polymorphonuclear cells, and Tamm
Horsfall glycoprotein, which inhibits bacterial adherence to
the bladder mucosal wawall

6. 
UTI occurs when the introduction of pathogens into this space
is associated with adherence to the mucosa of the urinary
tract.

If uropathogens are cleared inadequately by the washout
effect of voiding, then microbial colonization potentially
develops.

7. 
Colonization may be followed by microbial multiplication and
an associated inflammatory response.

Bacteria that cause UTI in otherwise healthy hosts often
exhibit distinctive properties—known as virulence factors

8. 
Urinary tract infections (UTIs) occur in 1% of boys and 1-3% of
girls.

T he prevalence of UTIs varies with age.

During the 1st yr of life, the male : female ratio is 2.8-5.4 :
1.

Beyond 1-2 yr, there is a female preponderance, with a
male : female ratio of 1 : 10.

9. • Bacterial infections are the most common.
• E coli is the most common causing 75-90% of UTI episo
des. Other bacteria include:
• Klebsiella species
• Proteus species
• Enterococcus species
• Staphylococcus saprophyticus
• Adenovirus (rare)
• Fungal in immune compromised patients
Etiology

10. Risk Factors

11. CLINICAL MANIFESTATIONS AND CLASSIFICATION

The 3 basic forms of UTI are:-
.1
Pypyelonephritis
.2
Cystitis, and
.3
Asymptomatic bacteriuria.

12. Clinical Pyelonephritis

Clinical pyelonephritis is characterized by any or all of the
following:
–
abdominal, back, or flank pain;
–
fever; malaise; nausea; vomiting; and,
–
occasionally, diarrhea.
–
Fever may be the only manifestation.

13. 
Newborns can show nonspecific symptoms such as poor
feeding, irritability, jaundice, and weight loss.

Pyelonephritis is the most common serious bacterial infection
in infants younger than 24 mo of age who have fever without
an obvious focus

14. 
These symptoms are an indication that there is bacterial
involvement of the upper urinary tract.

Acute pyelonephritis can result in renal injury, termed
pyelonephritic scarring.

15. Cystitis

Cystitis indicates that there is bladder involvement

symptoms include:-

dysuria, urgency, frequency,

suprapubic pain,

incontinence, and malodorous urine

16. 
Cystitis does not cause fever and does not result in renal
injury.

Malodorous urine is not specific for a UTI.

17. Asymptomatic Bacteriuria

Asymptomatic bacteriuria refers to a condition in which there
is a positive urine culture without any manifestations of
infection.
•
It is most common in girls
•
The incidence is <1% in preschool and schoolage girls and is
rare in boboy
•
This condition is benign and does not cause renal injury,
except in pregnant women, in whom asymptomatic
bacteriuria, if left untreated, can result in a symptomatic UTI.

18. Diagnosis
•
The definitive diagnosis of a UTI requires the isolation of at
least one uropathogen from a urine culture
•
Urine, which should be obtained before the initiation of
antimicrobial therapy, can be collected by various methods.

19. •
The AAP recommends suprapubic aspiration or urethral
catheterization to establish a diagnosis of UTI in neonates and
young children.
•
Aclean-catch specimen may be obtained from older children
and young adults.

20. Urinalysis:
– A urine specimen that is found to be positive for nitrite, le
ukocyte esterase, or blood may indicate a UTI.
– Microscopic examination can evaluate presence of WBCs (
>5 per high-power field), RBCs, bacteria, casts, and skin co
ntamination (e.g., epithelial cells).

22. TREATMENT

Acute cystitis
–
3- to 5-day course of therapy with

trimethoprim-sulfamethoxazole (TMP-SMX) trimethoprim
is effective against many strains of E. coli.

23. 
Nitrofurantoin (5-7 mg/ kg/24 hr in 3-4 divided doses) also is
effective and has the advantage of being active against
Klebsiella and Enterobacter organisms.

Amoxicillin (50 mg/kg/24 hr) also is effective as initial
treatment but has a high rate of bacterial resistance.

24. 
Pyelonephritis

In acute febrile infections suggesting a 7-14 day course of
broad-spectrum antibiotics capable of reaching significant
tissue levels is preferable.

25. Indication for admission

Children who are :-

dehydrated, vomiting, unable to drink fluids,

1 mo of age or younger,

have complicated infection,

in whom urosepsis is a possibility

admitted to the hospital for IV rehydration and IV
antibiotic therapy.

26. Reurrent UTI:

Two or more UTIs over a six months period.

There will be a period of remission followed by a recurrence
of the infection

Causes:

Inadequate treatment either due to compliance or improper
prescription.

unrecognized site of bacterial persistence such as small infected calculus
o

un recognized anatomic abnormality.