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Pediatric urinary tract infection

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pediatric urinary tract infection

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Pediatric urinary tract infection

  1. 1. Pediatric Urinary tract infection Dr. Srinivasaraghavan. R AP, Department of Pediatrics
  2. 2. Objectives • Forms of UTI in children • Diagnosis of UTI • Treatment of UTI • Complications • Recurrent UTI- risk factors
  3. 3. Why know about pediatric UTI? • One of the commonest infections in children • Young infants- sepsis- mortality if not recognized • Renal scarring- hypertension and progressive renal damage
  4. 4. Epidemiology • 1% of all boys and 1-3% of all girls- UTI • 1st yr- M:F- 2.8-5.4 : 1 • Beyond 1-2 yr- M:F -1 : 10
  5. 5. Forms UTI FORMS CYSTITIS/ LOWER UTI PYELONEPHRITIS/ UPPER UTI
  6. 6. Etiologic organisms • Uropathogens- mostly bacteria from stools- ascending infection from peri-urethral area or via bacteremia • Bacteria- E.coli (most common- 75-90%), Klebsiella, Proteus, Pseudomonas aeruginosa, Staphylococcus saprophyticus, GBS • Candida • Adenovirus- hemorrhagic cystitis
  7. 7. Symptoms Upper UTI • High grade fever, toxic look • Vomiting, nausea • Abdominal pain- flanks • Diarrhea Cystitis • Dysuria • Urgency • Frequency • Supra-pubic pain • Hematuria • Usually no fever
  8. 8. Simple vs complicated UTI • Complicated – Presence of fever >39 ⁰C – systemic toxicity – persistent vomiting – dehydration – renal angle tenderness – raised creatinine • Simple – low grade fever – Dysuria, frequency, and urgency – absence of symptoms of complicated UTI
  9. 9. Symptoms contd.. • 0-2 months- sepsis- poor feeding, lethargy- rarely cholestasis and failure to thrive • 2months- 2 years- fever without focus • Older children- may present as secondary enuresis
  10. 10. Evaluation • Fever? Other symptoms? • Feeding well? Vomiting? • Toxic? Dehydrated? • Shock features? Sepsis? • Spine examination and genitalia- Bladder- bowel dysfunction
  11. 11. Phimosis
  12. 12. Phimosis
  13. 13. Diagnosis • Counts- WBC counts high in upper UTI, serum creatinine • Screening – Urine microscopy- leukocytes – Rapid dipstick tests- leukocyte esterase and nitrite • Obtaining sample: – Midstream clean catch- cleaning with soap and water – Urine bag samples- not good – Neonates and infants- suprapubic aspiration/ transurethral bladder catheterization • Plate within 1 hour- if delay anticipated- refrigerator at 4⁰C for up to 12-24 hours
  14. 14. Diagnosis • Urine culture- gold standard
  15. 15. Treatment • < 3 months of age and those with complicated UTI- hospitalized, parenteral antibiotics • Ceftriaxone/ Cefotaxime/ Amikacin/ Gentamicin • Others- oral therapy- Cefixime/ Cephalexin/ Amoxy-clav/ Ciprofloxacin • Symptoms mild/ diagnosis doubtful- delayed until the results of culture
  16. 16. Duration • Infants and children with complicated UTI- 10- 14 days • Uncomplicated UTI- 7-10 days • Adolescents with cystitis- 3 days • Supportive measures- hydration
  17. 17. Culture proven UTI- Follow up Investigation < 1 yr 1- 5 yr > 5 yr USG + + + DMSA + + Only if USG abnormalMCU + Only if any of the above is abnormal
  18. 18. DMSA • Right lower pole and left kidney scarring + • Normal study
  19. 19. Recuurent UTI- risk factors • Bowel and bladder dysfunction • Structural abnormalities of the urinary tract- VUR, PUV, duplex ureter • Constipation • Catheterization • Worm infestation • Alteration of peri-urethral flora by antibiotic therapy
  20. 20. Prevention • Adequate fluid intake • Frequent voiding • Constipation- avoided • Circumcision- high grade reflux in children
  21. 21. VUR • 40-50% infants and 30-50% children with UTI • Primary vs secondary • Secondary VUR- bladder outflow obstruction, as with posterior urethral valves, neurogenic bladder or a functional voiding disorder
  22. 22. VUR Grades • Classification- based on MCU appearance- grade I to V- I to III- Low grade, IV and V- high grade • Bilateral grade IV and grade V- risk factor for pyelonephritis and scarring
  23. 23. MCU
  24. 24. Treatment • Prevention of recurrent UTI- Antibiotic prophylaxis till 5 years of age • Low grade VUR- subsides spontaneously • High grades- need surgical repair
  25. 25. Take home messages • Causes of UTI in children • Upper UTI vs Lower UTI • Diagnosis • Treatment guidelines

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