Uti in children

1. Urinary Tract Infection In Children
Dr. Alia Al-Ibrahim
Consultant Pediatric Nephrology
Clinical Assistant Professor

2. Contents:
1- Definition of UTI
2- Etiology & pathogenesis
3- Predisposing Factors
4- Clinical presentations
5-Investigations
6- Management
7- Complications
8- Special problems in UTI

3. Definition:
Presence of bacteria in urine along with symptoms of infection.
Incidence:
5% in Girls 1-2% in Boys
During the 1st yr of life more common in boys, after age of one more in girls
Etiology:
Most common infecting pathogen : Escherichia Coli 80% of UTI.
Other pathogens: - Staphylococcus & Streptococcus Species
- Enterobacteria ( Klebsiella, Proteus, pseudomonas)
- Occasionally Candida albicans
UTI in Children

4. Route of infection:
Neonate: Hematogenous
Later : Ascension of bacteria into the Urinary tract.
Development of UTI depend on:
1- Virulence of the invading bacteria.
2- Susceptibility of the host.
Predisposing factors:
1- Conditions lead to urinary stasis : renal calculi, Obstructive Uropathy ,
VUR, & Voiding disorder.
2- Immune deficiency
3- Broad- spectrum antibiotics ( amoxicillin, cephalexin).
4- constipation
5- uncircumcised male

5. Clinical Presentation:
1- Upper UTI (Pyelonephritis).
2- Lower UTI ( Cystitis).
The history & clinical coarse varies with the patient’s age & specific diagnosis.

6. 0-2months: sepsis
2mon-2yrs: unexplained fever
irritability, poor oral intake, abdominal pain, vomiting, loose
bowel movement.
voiding symptoms of cystitis
crying on urination
smelly urine
no fever or mild
2yrs :
Pyelonephritis( fever, irritability, poor appetite, abdominal flank
pain back pain, voiding symptoms, tenderness in
costovertebral angle or flank.
cystitis : voiding symptoms ( urgency, frequency, hesitancy, dysuria,
urinary incontinence)
mild or no fever, Suprapubic or abdominal pain

7. >Pyuria, proteinuria & Hematuria may occur with or without UTI.
>Nitrite concentrations & leukocyte estrase
POSITIVE URINE CULTURE IS ESSENTIAL FOR DIAGNOSIS OF UTI.
Urine culture:
-Suprapubic : any number of colonies.
- IN-and- out catheterization: > 10³. E.COLI
- Midstream clean-catch urine collection > 10,000
-Single organism
- 2 or more contamination. E.COLI
-Blood culture :neonate & infant
-Pyelonephritis: CBC: neutrophlic leukocytosis
high ESR
C-reactive protein. Proteus Pseudomonas
Distinction between upper & lower difficult in children
-Urine analysis & dipstick:High index of suspicion for UTI in febrile children
particularly those with unexplained fever. Lasts for 2-3days;
-> 5 WBC/ hpf in centrifuged fresh urine positive screening test.
- >Bacteria in cent. & non cent. Or phase contrast suggestible of UTI.

8. Management:
< 5 yrs:
With systemic signs:
1- Iv antibiotics shift to oral after improvement , duration 10 -14 days.
2- US , renal cortical scintigraphy ( DMSA) , MCUG.
No systemic signs:
1- oral antibiotics for 7-10 days
US, MCUG( if indicated)
5 yrs
Female: Female & Male with signs
1- no signs : oral antibiotics Like < 5 yrs
Male:
1- No signs: oral antibiotics
2- US, MCUG

9. COMPLICATIONS:
1- VUR
2- Scarring
3- HTN
4- Renal insufficiency.
Normal DMSA Acute Pyelonephritis Scarring
VUR

10. Special problems
1-Reurrent UTI:
Two or more UTIs over a six –months period.
Causes: Inadequate treatment.
unrecognized site of bacterial persistence such as small infected
calculus or un recognized anatomic abnormality.
2-VUR:
Abnormal backwash of urine into ureter or kidney
Radiological evaluation VCUG, Isotope cystogrm

11. 3-Breakthrough UTI:
Caused by:
1- change in the resistance pattern of organisms colonizing the
urethra.
2- noncompliance.
3- VUR
4- Voiding dysfunction.
4-Voiding dysfunction:
Detrusor instability & incomplete bladder emptying
-Associated with daytime enuresis & constipation.
- Increase risk of UTI & VUR.
-RX: 1- Timed voiding
2- Treatment of constipation.
3- Prophylactic antibiotics.
4- Anticholinergic medications.
5-Asymptomatic bacteruria:
No need for antibiotics, low risk of scarring.