This slides gives a basic understanding of urinary tract infections to a general physician, it's definition,epidemiology, causes, risk factors, clinical features, investigations, treatment and prevention. It also helps a physician to have the ability on to mange urinary tract infections in paediatric patients.

1. PAEDIATRIC UTI
BY NAWA .M.S

2. OUTLINE
• DEFINITION
• EPIDERMIOLOGY
• CAUSES
• RISK FACTORS
• CLINICAL FEATURES
• DIAGNOSIS
• TREATMENT
• PREVENTION

3. DEFINITION
• Infection of the urinary tract
• PRESENTS AS:
• UPPER UTI- acute and chronic pyelonephritis(infection of the kidney)
• LOWER UTI- acute and chronic cystitis(infection of the urinary bladder)/urethritis
• ASYMPTOMATIC BACTERIURIA
• SEPTICEMIA

5. EPIDERMIOLOGY
• Most common childhood bacterial infection in childhood- although not usually or
oftenly diagnosed.
• maybe a warning event for a renal abnormality but normal anatomy is more common.
• MALE TO FEMALE RATIO(M:F)
• 1st year of life-M:F is 2.8-5.4:1, reason: diagnosis of posterior urethral valves is made
at this age.
• at 2 years of life-M:F is 1:10
• NOTE: prompt diagnosis and initiation of treatment is important as it helps in
prevention of renal scarring.

6. CAUSES
• Klebisella spp
• E. coli(most common cause)
• Enterococcus
• Enterobacter spp
• Proteus(more in boys)
• Staphylococcus spp(S.aureus, S.saprophyticus)
• Adenovirus
• Pseudomonas
• Group b streptococcus
• Candida spp
• NOTE: Important causes of acute hemorrhagic cystitis are Adenovirus(types 11 and
21), E.coli and polyomavirus(JC VIRUS and BK VIRUS).

7. RISK FACTORS

9. CLINICAL FEATURES
• Vary depending on age of child and location of infection:

11. • IN OLDER CHILDREN
• fever
• dysuria
• incontinence
• macroscopic
• frequency
• macroscopic hematuria
• abdominal pain
• urgency
• hesitancy
• DIFFERENTIAL: nocturnal enuresis
• note: if flank pain an chills then pyelonephritis, if dysuria, urgency, frequency,
suprapubic pain, incontinence and possibly maldarous urine then cystitis.

12. DIAGNOSIS

13. CLICK ON A4 OR PLACE POINTER
ON A4..

14. ADDITIONAL TESTS
• 1.) URINE DIPSTICK- check for positive nitrite and positive leukocyte esterase
• 2.) PYURIA- suggests infection, positive if >/= 5 WBCS/HPF or >/= 10WBCS/ml
• 3.) GRAM STAINING- for bacteriuria
• 4.) PYELONEPHRITIS INDICATORS- leukocytosis, neutrophilia, elevated ESR,
elevated C-reactive protein, positve blood cultures and DMSA scan.
• 5.) IMAGING:

16. TREATMENT
• 1.) RELIEF OF SYMPTOMS:
• pain and fever- give analgesia and antipyretics
• vomiting and dehydrated- rehydrate with fluids
• 2.) ERADICATTION OF INFECTIOUS AGENT:
• give antibiotics
• NOTE: choice of antibiotics is dependant on:
• age- for neonates and infants < 3months, parenteral antibiotics are
recommended.
• severity of illness
• refusal of oral intake
• non compliance with oral medication
• potential complicated febrile illness

17. NOTE: alternative for ampicilin is crystalline penicillin which is also given along an
aminoglycoside.

18. • 3.)TO IDENTIFY THOSE WHO ARE AT RISK OF RENAL SCRRING

19. PREVENTION
• High fluid intake
• regular bladder emptying
• good hygiene
• prevent or treat risk factors e.g. bladder stones, constipation, voiding dysfunction
• probiotic and cranberry juice as an added benefit

20. REFERENCES
• ILLUSTRATED BABY NELSON SPECIAL PEDIATRICS BY DR MOHAMED KOUMI
• NELSONS TEXTBOOK OF PEDIATRICS(20TH EDITION). URINARY TRACT
INFECTIONS
• URINARY TRACT INFECTIONS BY DR CHANDA KAPOMA