This document summarizes recurrent urinary tract infections (UTIs) in children. It defines UTIs and discusses epidemiology, clinical features, diagnosis, treatment, risk factors, complications like vesicoureteral reflux (VUR) and renal scarring, and prevention. Evaluation and long-term management of UTIs depends on identifying and addressing underlying causes like VUR, obstruction, dysfunctional voiding, or hypercalciuria.
Up to 7% of girls and 2% of boys will experience a urinary tract infection by age 6. Diagnosis requires a urine culture if there is high clinical suspicion based on symptoms like fever, cloudy urine, or a positive dipstick test. While imaging studies were once routinely recommended, evidence now shows they do not improve outcomes for uncomplicated infections. Oral antibiotics are as effective as intravenous therapy, and short courses of 2-5 days may be sufficient though optimal duration is unclear.
A seminar on urinary tract infections (UTIs) was presented. UTIs are common in children and can lead to complications if not treated properly. The presentation covered the definition, causes, risk factors, clinical presentation, investigations, treatment, and follow-up management of UTIs in children of different ages. Proper diagnosis and treatment of UTIs as well as preventing recurrence are important to avoid long-term issues like renal scarring and kidney damage.
An infant presented with fever, vomiting, diarrhea and passing small amounts of urine daily for many days. Examination showed the infant was dehydrated and sick-looking. Urine examination showed many pus cells indicating a urinary tract infection (UTI). UTIs are caused mainly by E. coli and occur more commonly in girls and uncircumcised boys. Symptoms of UTI in infants can include fever, poor feeding and jaundice. Treatment involves antibiotics for a period of time depending on the severity and location of the infection. Imaging may be required depending on factors like previous infections or abnormalities found on examination.
This document provides an overview of urinary tract infections in children. Some key points include:
- UTIs are common in young children, especially girls under age 7 and uncircumcised boys under 1.
- Symptoms range from cystitis to more severe pyelonephritis. Proper diagnosis requires urinalysis and urine culture.
- Risk factors for UTIs and recurrent UTIs include anatomical abnormalities, functional issues, prior antibiotic use, and young age.
- Treatment involves antibiotics chosen based on local resistance patterns. Follow up includes imaging to identify issues like reflux.
- Antibiotic resistance is a growing problem, with varying resistance levels in different geographic regions.
This document provides an overview of urinary tract infections (UTIs) in children from a surgeon's perspective. Some key points:
- UTIs are common in infants and children, especially girls under 5 years old. Boys are more commonly affected in the first year of life.
- Evaluation of a child with UTI includes a physical exam, urine culture, and consideration of imaging like ultrasound based on factors like age, symptoms, recurrence.
- Common causes of UTIs include anatomical abnormalities like vesicoureteral reflux, posterior urethral valves, or ureteroceles.
- Treatment involves antibiotics tailored to culture results. Children with recurrent UTIs or anatomical issues may
URINARY TRACT INFECTION IN CHILDREN 2.pptxFoad Qacem
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are most common in children under 1 year of age and are more common in females than males. The most common causative bacteria is E. coli. Symptoms can include fever, back/flank pain, nausea, vomiting, and diarrhea for pyelonephritis or dysuria, urgency, frequency for cystitis. Diagnosis involves urinalysis, urine culture, and imaging tests as needed. Treatment involves antibiotics for 7-14 days with hospitalization sometimes needed for severe cases.
This document summarizes recurrent urinary tract infections (UTIs) in children. It defines UTIs and discusses epidemiology, clinical features, diagnosis, treatment, risk factors, complications like vesicoureteral reflux (VUR) and renal scarring, and prevention. Evaluation and long-term management of UTIs depends on identifying and addressing underlying causes like VUR, obstruction, dysfunctional voiding, or hypercalciuria.
Up to 7% of girls and 2% of boys will experience a urinary tract infection by age 6. Diagnosis requires a urine culture if there is high clinical suspicion based on symptoms like fever, cloudy urine, or a positive dipstick test. While imaging studies were once routinely recommended, evidence now shows they do not improve outcomes for uncomplicated infections. Oral antibiotics are as effective as intravenous therapy, and short courses of 2-5 days may be sufficient though optimal duration is unclear.
A seminar on urinary tract infections (UTIs) was presented. UTIs are common in children and can lead to complications if not treated properly. The presentation covered the definition, causes, risk factors, clinical presentation, investigations, treatment, and follow-up management of UTIs in children of different ages. Proper diagnosis and treatment of UTIs as well as preventing recurrence are important to avoid long-term issues like renal scarring and kidney damage.
An infant presented with fever, vomiting, diarrhea and passing small amounts of urine daily for many days. Examination showed the infant was dehydrated and sick-looking. Urine examination showed many pus cells indicating a urinary tract infection (UTI). UTIs are caused mainly by E. coli and occur more commonly in girls and uncircumcised boys. Symptoms of UTI in infants can include fever, poor feeding and jaundice. Treatment involves antibiotics for a period of time depending on the severity and location of the infection. Imaging may be required depending on factors like previous infections or abnormalities found on examination.
This document provides an overview of urinary tract infections in children. Some key points include:
- UTIs are common in young children, especially girls under age 7 and uncircumcised boys under 1.
- Symptoms range from cystitis to more severe pyelonephritis. Proper diagnosis requires urinalysis and urine culture.
- Risk factors for UTIs and recurrent UTIs include anatomical abnormalities, functional issues, prior antibiotic use, and young age.
- Treatment involves antibiotics chosen based on local resistance patterns. Follow up includes imaging to identify issues like reflux.
- Antibiotic resistance is a growing problem, with varying resistance levels in different geographic regions.
This document provides an overview of urinary tract infections (UTIs) in children from a surgeon's perspective. Some key points:
- UTIs are common in infants and children, especially girls under 5 years old. Boys are more commonly affected in the first year of life.
- Evaluation of a child with UTI includes a physical exam, urine culture, and consideration of imaging like ultrasound based on factors like age, symptoms, recurrence.
- Common causes of UTIs include anatomical abnormalities like vesicoureteral reflux, posterior urethral valves, or ureteroceles.
- Treatment involves antibiotics tailored to culture results. Children with recurrent UTIs or anatomical issues may
URINARY TRACT INFECTION IN CHILDREN 2.pptxFoad Qacem
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are most common in children under 1 year of age and are more common in females than males. The most common causative bacteria is E. coli. Symptoms can include fever, back/flank pain, nausea, vomiting, and diarrhea for pyelonephritis or dysuria, urgency, frequency for cystitis. Diagnosis involves urinalysis, urine culture, and imaging tests as needed. Treatment involves antibiotics for 7-14 days with hospitalization sometimes needed for severe cases.
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are commonly caused by Escherichia coli entering the urinary tract via the fecal-perineal-urethral route. Left untreated, upper UTIs can lead to renal scarring, hypertension, and end-stage renal disease. The gold standard for diagnosing UTIs is a urine culture with a threshold of 105 CFU/ml for a positive result. Treatment involves antibiotics chosen based on culture and sensitivity results, with recurrent infections requiring evaluation and possibly long-term prophylaxis to prevent renal damage.
Vesicoureteric Reflux in Children—Current ConceptsApollo Hospitals
Urinary tract infection (UTI) is a common problem in infants and young children affecting about 2–5% of all small
children. Almost a third to half of infants who are inflicted with urinary infection are likely to have an abnormal urinary
tract, commonest of which is vesicoureteric reflux (VUR). Around 10–20% of children with VUR end with hypertension
or end stage renal disease stressing the need to diagnose and manage these children early. This article reviews
current status of clinical manifestations, diagnosis, and management of children with VUR.
This document summarizes urinary tract infections (UTIs) in children. Key points:
- UTIs are common in children, especially young girls. Left untreated, they can cause renal damage.
- Diagnosis is made by urine culture showing significant bacterial growth. Symptoms vary from asymptomatic to fever and abdominal pain.
- Risk factors include being female, age under 5 years, and anatomical abnormalities like vesicoureteral reflux.
- Treatment involves antibiotics, with hospitalization for young infants or complicated cases. Recurrent UTIs may require long-term antibiotics.
- Evaluation after first UTI assesses risk of renal damage through ultrasound, DMSA scan, and voiding cystourethro
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
Urinary tract infections (UTIs) are common in children and can lead to renal scarring if not treated promptly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires significant bacteriuria on urine culture along with pyuria on urinalysis. Risk factors for UTIs in children include age, lack of circumcision, race, and underlying anatomical or functional abnormalities of the urinary tract. Prompt diagnosis and treatment of UTIs in children can help prevent long-term kidney damage.
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
This document discusses urinary tract infections (UTIs) in children. It provides information on the definition, prevalence, types, symptoms, causative organisms, pathogenesis, diagnosis and management of UTIs in children of different age groups. The key points are: UTIs are common in young children and involve the bladder (cystitis) or kidneys (pyelonephritis). E. coli is the most common causative organism. Diagnosis involves urinalysis, urine culture and imaging tests like ultrasound and DMSA scan. Treatment depends on the severity but commonly involves oral antibiotics like trimethoprim-sulfamethoxazole for 3-5 days. Recurrent UTIs may require long-term antibiotic prophyl
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are common in childhood and can lead to renal scarring if not treated properly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires a positive urine culture. Treatment involves antibiotics, with younger or more severely infected children needing hospitalization. Recurrent UTIs may indicate an underlying condition like vesicoureteral reflux.
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are common in childhood and can lead to renal scarring if not treated properly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires a positive urine culture. Treatment depends on factors like age and infection severity, but commonly involves antibiotics. Recurrent UTIs and vesicoureteral reflux increase the risk of renal damage, so preventative measures and follow-up are important.
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
This document provides an overview of pediatric urinary tract infections (UTIs). It discusses the typical presentation of UTIs in children, risk factors, diagnostic testing including urine culture and imaging, and treatment including antibiotics. Imaging plays an important role in diagnosis of conditions like vesicoureteral reflux that can lead to recurrent infections or renal scarring. While routine antibiotics or surgery are options for certain high risk cases, there is debate around their clinical benefits.
This document provides clinical guidelines for the diagnosis and management of hypertrophic pyloric stenosis (HPS) in infants. It discusses that HPS most commonly presents between 2-8 weeks of age with projectile non-bilious vomiting. Diagnosis can be made by palpating an olive-shaped pyloric mass, though ultrasound or upper GI series can also detect pyloric thickening. Surgical pyloromyotomy is the treatment, with careful attention to hydration status and pain management post-operatively. Infants are typically advanced to full feedings and discharged once tolerating feeds without other complications.
This document provides clinical guidelines for the diagnosis and management of hypertrophic pyloric stenosis (HPS) in infants. It discusses that HPS most commonly presents between 2-8 weeks of age with non-bilious projectile vomiting. Diagnosis can be made by palpating an olive-shaped pyloric mass, though ultrasound or upper GI series can also detect pyloric thickening. Surgical pyloromyotomy is the treatment, with careful attention to hydration status and pain management post-operatively. Infants are typically advanced to full feedings and discharged once tolerating meals without other complications.
- UTI is the second most common bacterial infection in children, with E. coli being the most common causative organism. Infants under 1 year old and females over 1 year old are more susceptible to UTIs.
- Risk factors for UTI include perineal colonization by intestinal flora, dysfunctional voiding, constipation, and presence of VUR. VUR increases the risk of renal scarring from UTIs.
- Treatment of UTIs depends on whether it is cystitis or pyelonephritis. Children under 5 with a UTI should be evaluated for VUR with a cystogram. The goal is to identify reflux and reduce risk of renal scarring through prophylactic
Urinary tract infection in children.pptxXavier875943
UTI is a common bacterial infection in children that can lead to renal scarring and other long term issues if not properly treated. It is more common in girls than boys, especially around the time of toilet training. The most common causative organism is E. coli. Diagnosis involves urine culture and microscopy showing bacteria and white blood cells. Treatment consists of a course of oral antibiotics. For recurrent UTIs or those indicating renal involvement, further imaging may be needed to identify issues like vesicoureteral reflux that require prophylactic treatment or surgery. Complications can include recurrent infections, renal scarring, hypertension, and even end stage renal failure if not adequately managed.
Urinary tract infections can lead to acute kidney injury in children. Common causes of acute kidney injury include urinary tract infections and conditions that decrease blood flow to the kidneys. Symptoms may include decreased urine output or edema. Diagnosis involves urine and blood tests to evaluate kidney function. Treatment focuses on resolving the underlying cause, increasing fluid intake, and antibiotics if infection is present. Complications can include dehydration or long-term kidney damage if not properly treated.
This document provides information on intussusception in children. It discusses that intussusception is the telescoping of one segment of intestine into another and is most common in children under 1 year old. It can be idiopathic or have a pathological lead point such as Meckel's diverticulum. Diagnosis is usually made clinically or with ultrasound or contrast enema. Treatment involves non-operative reduction with hydrostatic or pneumatic enema, which has a high success rate. Surgery is needed if reduction fails or there are complications like perforation. Prognosis is generally excellent with prompt treatment.
This document provides an overview of childhood enuresis (bedwetting), including definitions, epidemiology, etiology, clinical manifestations and diagnosis, and treatment options. It defines primary and secondary enuresis and notes that psychological problems are usually a result rather than a cause. Treatment options discussed include supportive management, alarm therapy, desmopressin, anticholinergic medications like oxybutynin, and imipramine. Alarm therapy and desmopressin are identified as the most effective evidenced-based treatments.
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are commonly caused by Escherichia coli entering the urinary tract via the fecal-perineal-urethral route. Left untreated, upper UTIs can lead to renal scarring, hypertension, and end-stage renal disease. The gold standard for diagnosing UTIs is a urine culture with a threshold of 105 CFU/ml for a positive result. Treatment involves antibiotics chosen based on culture and sensitivity results, with recurrent infections requiring evaluation and possibly long-term prophylaxis to prevent renal damage.
Vesicoureteric Reflux in Children—Current ConceptsApollo Hospitals
Urinary tract infection (UTI) is a common problem in infants and young children affecting about 2–5% of all small
children. Almost a third to half of infants who are inflicted with urinary infection are likely to have an abnormal urinary
tract, commonest of which is vesicoureteric reflux (VUR). Around 10–20% of children with VUR end with hypertension
or end stage renal disease stressing the need to diagnose and manage these children early. This article reviews
current status of clinical manifestations, diagnosis, and management of children with VUR.
This document summarizes urinary tract infections (UTIs) in children. Key points:
- UTIs are common in children, especially young girls. Left untreated, they can cause renal damage.
- Diagnosis is made by urine culture showing significant bacterial growth. Symptoms vary from asymptomatic to fever and abdominal pain.
- Risk factors include being female, age under 5 years, and anatomical abnormalities like vesicoureteral reflux.
- Treatment involves antibiotics, with hospitalization for young infants or complicated cases. Recurrent UTIs may require long-term antibiotics.
- Evaluation after first UTI assesses risk of renal damage through ultrasound, DMSA scan, and voiding cystourethro
This was a joint lecture for the Chong Hua Hospital Postgraduate Course by OB-infectious disease specialist Dr Helen Madamba and IM-infectious disease specialist Dr Mitzi Chua.
Urinary tract infections (UTIs) are common in children and can lead to renal scarring if not treated promptly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires significant bacteriuria on urine culture along with pyuria on urinalysis. Risk factors for UTIs in children include age, lack of circumcision, race, and underlying anatomical or functional abnormalities of the urinary tract. Prompt diagnosis and treatment of UTIs in children can help prevent long-term kidney damage.
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
This document discusses urinary tract infections (UTIs) in children. It provides information on the definition, prevalence, types, symptoms, causative organisms, pathogenesis, diagnosis and management of UTIs in children of different age groups. The key points are: UTIs are common in young children and involve the bladder (cystitis) or kidneys (pyelonephritis). E. coli is the most common causative organism. Diagnosis involves urinalysis, urine culture and imaging tests like ultrasound and DMSA scan. Treatment depends on the severity but commonly involves oral antibiotics like trimethoprim-sulfamethoxazole for 3-5 days. Recurrent UTIs may require long-term antibiotic prophyl
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are common in childhood and can lead to renal scarring if not treated properly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires a positive urine culture. Treatment involves antibiotics, with younger or more severely infected children needing hospitalization. Recurrent UTIs may indicate an underlying condition like vesicoureteral reflux.
This document discusses urinary tract infections (UTIs) in children. It notes that UTIs are common in childhood and can lead to renal scarring if not treated properly. Escherichia coli is the most common cause of UTIs in children. The diagnosis of a UTI requires a positive urine culture. Treatment depends on factors like age and infection severity, but commonly involves antibiotics. Recurrent UTIs and vesicoureteral reflux increase the risk of renal damage, so preventative measures and follow-up are important.
This presentation covers Urinary tract Infections (UTI). Their Definition, forms, epidemiology, risk factors, etiology, Clinical manifestation, Diagnostic procedures, Management, Complications and Education to the Patients are discussed in detail.
This document provides an overview of pediatric urinary tract infections (UTIs). It discusses the typical presentation of UTIs in children, risk factors, diagnostic testing including urine culture and imaging, and treatment including antibiotics. Imaging plays an important role in diagnosis of conditions like vesicoureteral reflux that can lead to recurrent infections or renal scarring. While routine antibiotics or surgery are options for certain high risk cases, there is debate around their clinical benefits.
This document provides clinical guidelines for the diagnosis and management of hypertrophic pyloric stenosis (HPS) in infants. It discusses that HPS most commonly presents between 2-8 weeks of age with projectile non-bilious vomiting. Diagnosis can be made by palpating an olive-shaped pyloric mass, though ultrasound or upper GI series can also detect pyloric thickening. Surgical pyloromyotomy is the treatment, with careful attention to hydration status and pain management post-operatively. Infants are typically advanced to full feedings and discharged once tolerating feeds without other complications.
This document provides clinical guidelines for the diagnosis and management of hypertrophic pyloric stenosis (HPS) in infants. It discusses that HPS most commonly presents between 2-8 weeks of age with non-bilious projectile vomiting. Diagnosis can be made by palpating an olive-shaped pyloric mass, though ultrasound or upper GI series can also detect pyloric thickening. Surgical pyloromyotomy is the treatment, with careful attention to hydration status and pain management post-operatively. Infants are typically advanced to full feedings and discharged once tolerating meals without other complications.
- UTI is the second most common bacterial infection in children, with E. coli being the most common causative organism. Infants under 1 year old and females over 1 year old are more susceptible to UTIs.
- Risk factors for UTI include perineal colonization by intestinal flora, dysfunctional voiding, constipation, and presence of VUR. VUR increases the risk of renal scarring from UTIs.
- Treatment of UTIs depends on whether it is cystitis or pyelonephritis. Children under 5 with a UTI should be evaluated for VUR with a cystogram. The goal is to identify reflux and reduce risk of renal scarring through prophylactic
Urinary tract infection in children.pptxXavier875943
UTI is a common bacterial infection in children that can lead to renal scarring and other long term issues if not properly treated. It is more common in girls than boys, especially around the time of toilet training. The most common causative organism is E. coli. Diagnosis involves urine culture and microscopy showing bacteria and white blood cells. Treatment consists of a course of oral antibiotics. For recurrent UTIs or those indicating renal involvement, further imaging may be needed to identify issues like vesicoureteral reflux that require prophylactic treatment or surgery. Complications can include recurrent infections, renal scarring, hypertension, and even end stage renal failure if not adequately managed.
Urinary tract infections can lead to acute kidney injury in children. Common causes of acute kidney injury include urinary tract infections and conditions that decrease blood flow to the kidneys. Symptoms may include decreased urine output or edema. Diagnosis involves urine and blood tests to evaluate kidney function. Treatment focuses on resolving the underlying cause, increasing fluid intake, and antibiotics if infection is present. Complications can include dehydration or long-term kidney damage if not properly treated.
This document provides information on intussusception in children. It discusses that intussusception is the telescoping of one segment of intestine into another and is most common in children under 1 year old. It can be idiopathic or have a pathological lead point such as Meckel's diverticulum. Diagnosis is usually made clinically or with ultrasound or contrast enema. Treatment involves non-operative reduction with hydrostatic or pneumatic enema, which has a high success rate. Surgery is needed if reduction fails or there are complications like perforation. Prognosis is generally excellent with prompt treatment.
This document provides an overview of childhood enuresis (bedwetting), including definitions, epidemiology, etiology, clinical manifestations and diagnosis, and treatment options. It defines primary and secondary enuresis and notes that psychological problems are usually a result rather than a cause. Treatment options discussed include supportive management, alarm therapy, desmopressin, anticholinergic medications like oxybutynin, and imipramine. Alarm therapy and desmopressin are identified as the most effective evidenced-based treatments.
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This document defines AKI and describes its incidence, pathogenesis, clinical manifestations, diagnostic findings, and management. AKI is defined as an increase in serum creatinine or a decrease in urine output. It affects 2-5% of hospitalized patients and over 25% of critically ill children. AKI can be pre-renal from low blood volume, intrinsic renal from direct kidney damage, or post-renal from urinary tract obstruction. Laboratory and urinary findings help distinguish the type of AKI. Management involves fluid resuscitation and monitoring for complications.
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- Urinary tract infections (UTIs) are common in children and can lead to serious complications if left untreated. The two main types are pyelonephritis, which involves the kidneys, and cystitis, which involves the bladder.
- Symptoms vary with age but may include fever, abdominal pain, vomiting, and abnormal urine odor or color. Physical exams can reveal costovertebral angle tenderness or abdominal tenderness.
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2. Objectives
Define Urinary Tract Infection (UTI)
List antibiotic treatment options for UTI
List the workup after a first febrile UTI
Be familiar with the rationale for using
prophylactic antibiotics after the first febrile
UTI
3. Pediatric UTIs and EBM
Up to 7% of girls and 2% of boys experience a
symptomatic culture-proven UTI prior to 6
years of age.
Of febrile neonates, up to 7% have UTIs.
(See Fever without a source guidelines)
Most UTIs in children are from ascending
bacteria
E. coli (60-80%), Proteus, Klebsiella, Enterococcus,
and coag. neg. staph.
4. Epidemiology
The overall prevalence of UTI is approximately 5
percent in febrile infants but varies widely by race and
sex.
Caucasian children had a two- to fourfold higher
prevalence of UTI as compared to African-American
children
Females have a two- to fourfold higher prevalence of
UTI than do circumcised males
Caucasian females with a temperature of 39 ºC have a
UTI prevalence of 16 percent
5. Approximate probability of urinary tract infection
in febrile infants and young children by
demographic group
Demographic group
Prevalence (pretest
probability)
Odds
Circumcised boys >1 yr <1 percent .01 (1 in 100)
Circumcised boys <1 yr 2 percent .02 (1 in 50)
Black girls 4 percent .04 (1 in 25)
Uncircumcised boys <2
yr
8 percent .09 (1 in 12)
White girls <2 yr 16 percent .19 (1 in 5)
6. Definition of UTI on culture
Method of urine collection Diagnostic threshold
Clean-catch in voiding girls 100,000 CFU per mL
10,000 – 100,000 repeat culture
Clean-catch in voiding boys 10,000 CFU per mL
Catheter 10,000 CFU
1,000 – 10,000 repeat culture
Suprapubic aspiration Any colonies of GNRs
More than a few thousand GPCs
7. Symptoms
Classic UTI symptoms in older children
Dysuria, frequency, urgency, small-volume voids,
lower abdominal pain.
Infants with UTIs have nonspecific symptoms
Fever, irritability, vomiting, poor appetite
9. Evaluation
In children with a high likelihood of UTI, a
urine culture is required.
In children with a low likelihood, a negative
dipstick in a clear urine reduces the need for
culture.
If the dipstick shows (+) LE and/or (+)
Nitrites, send a urine culture.
The dipstick is not sufficient to diagnose UTI’s
because false positives can occur.
10. Urine dipsticks
In a cohort study with an 18% baseline
prevalence of UTI, negative LE and nitrates on
dipstick had a negative predictive value of 96%.
NPV = True negative
_________________
True negative + false negative
11. Leukocyte Esterase and Nitrites
LE is produced from the breakdown of
leukocytes. Not always indicative of infection
Vaginitis/vulvitis can lead to inflammation without
infection + LE
Nitrites are produced by bacteria that metabolize
nitrates: E. coli, Klebsiella, Proteus (GNRs)
Much more predictive of UTI
GPCs do not produce nitrites
12. Blood cultures
Blood cultures are generally unnecessary in most
children with UTI.
They are more frequently positive in children
younger than two months whose urine grows
Group B strep or Staph. Aureus.
In general, we’ll send febrile children less than
two months old to the ER for emergent
evaluation/labs.
13. Treatment of UTIs
The efficacy of oral regimens is as effective as
parenteral regimens - this is great news for
outpatient therapy
If the child is not responding the empiric
treatment within two days while awaiting culture
results, repeat the urine culture and perform a
renal ultrasound.
14. Antibiotic Choices
Trimethoprim-sulfamethoxizole is a good choice
after two months of life
Other choices:
Amoxicillin – some resistance with E. coli
Cephalosporins: cefixime (Suprax), cefpodoxime
(Vantin), cefprozil (Cefzil), loracarbef (Lorabid)
No cephalosporins cover enterococcus
Treat for 7-14 days. One day course not
effective.
16. Vesicoureteral Reflux and
Treatment
Approximately 40% of children with febrile UTIs have
VUR.
Approximately 8% of children with febrile UTIs
demonstrate renal scarring when studied.
Treatment recommendations are made to stop the
progression of VUR with medications/antibiotics
and/or surgery.
No data/EBM demonstrate that treatment of VUR
prevents renal scarring, hypertension and CKD
17. Antibiotic prophylaxis
Children with VUR are treated prophylactically
with antibiotics to prevent potential renal
scarring.
Nitrofurantoin or trimethoprim-sulfamethoxizole
Half the standard dose administered at bedtime
Family physicians would generally have a
pediatric urologist involved to assist in making
treatment decisions.
18. How long to continue Abx?
Although the evidence is not conclusive, it appears the
risk of scarring diminishes with age.
Accordingly, some experts recommend cessation of
prophylaxis after age 5 to 7 years, even if low-grade
VUR persists.
In one study of 51 low-risk (no voiding abnormalities
or renal scarring) older children (mean age 8.6 years)
with grades I to IV VUR, cessation of prophylactic
antibiotics resulted in no new renal scarring on annual
DMSA
19. Indications to order radiologic
studies
Children younger than 5 years of age with a
febrile UTI
Girls younger than 3 years of age with a first
UTI
Males of any age with a first UTI (PUV)
Children with recurrent UTI
Children with UTI who do not respond
promptly to therapy
20. Studies to consider
Renal Ultrasound
Will evaluate for perinephric abscess in patients not
responding to antibiotics.
Can evaluate for hydronephrosis/hydroureter
Of note, dilation of the kidneys and ureters can
easily be seen on routine anatomy scans during
pregnancy.
Picking up vesicoureteral reflux while asymptomatic
Does this help or hurt? Staging of VUR, antibiotics, etc...
25. Studies to consider
Voiding cystourethrogram – two techniques
One involves fluoroscopic contrast – more radiation
but better delineation of anatomy for grading VUR
The other uses a radionuclide – less radiation and
more sensitive than contrast
29. Studies to consider
Renal scintigraphy using dimercaptosuccinic acid
(DMSA)
Can detect scarring in the kidneys.
Renal cells take up the tracer.
Those cells damaged by pyelonephritis or scarring
do not take up the tracer.
Management or followup of patients does not
change in most cases.
Thus, not generally used for initial evaluation.
31. Myths
Bathing in bubble baths causes UTIs
Wiping back-to-front causes UTIs
Cranberry juice helps UTIs – only proven to be
of minimal benefit in adult women. No proven
benefit to children
32. VUR Treatment
Children 6 years or older with unilateral grade III to IV reflux
without renal scarring can be treated medically. If the reflux is
bilateral and/or there is renal scarring, surgical treatment is
recommended.
Children 6 years or older with grade V reflux should be treated
surgically with or without evidence of renal scarring, as their
reflux is unlikely to resolve spontaneously.
Surgery also should be considered if medical therapy fails either
because of poor compliance, breakthrough infections on account
of antibiotic resistance, or significant antibiotic side effects.
Finally, consideration of patient and parent preference is
important in the final decision.
33. Objectives
Define Urinary Tract Infection (UTI)
>100,000 CFU in clean catch girls
>10,000 CFU clean catch guys
>10,000 catheter specimen
List antibiotic treatment options for UTI
Amoxicillin, Bactrim, Cephalosporins
List the workup after a first febrile UTI
Consider renal U/S and VCUG
Be familiar with the rationale for using prophylactic antibiotics
after the first febrile UTI
Prevent renal complications/scarring/pyelonephritis