Urinary tract infection catheter related infections

1. Urinary tract infections in children

2. Diagnostic evaluation
• Medical history
• Clinical signs and symptoms
• Physical examination.
• Urine sampling, analysis and culture :
 Urine sampling:
Urine must be collected under defined conditions and investigated
as soon as possible to confirm or exclude UTI, there are four main
methods with varying contamination rates and invasiveness to
obtain urine:

3. 1. Plastic bag attached to the cleaned genitalia
2. Clean-catch urine (CCU) collection
3. Transurethral bladder catheterization
4. Suprapubic bladder aspiration
 Urinalysis:
There are three methods that are commonly used for urinalysis:

4. 1. Dipsticks: These are appealing because they provide rapid results,
do not require microscopy, and are ready to use.
2. Microscopy: This is the standard method of assessing pyuria
3. Flow imaging analysis technology: This is being used increasingly to
classify particles in uncentrifuged urine specimens

5.  Urine culture:
• After negative results for dipstick, microscopic or automated urinalysis,
urine culture is generally not necessary, especially if there is an
alternative source of fever. If the dipstick result is positive, confirmation
by urine culture is strongly recommended.
• A negative culture with the presence of pyuria may be due to
incomplete antibiotic treatment, urolithiasis, or foreign bodies in the
urinary tract, and infections caused by Mycobacterium tuberculosis or
Chlamydia trachomatis.

6. • Imaging:
 Ultrasound:
• Renal and bladder US within 24 hours is advised in infants with febrile
UTI to exclude obstruction of the upper and lower urinary tract. Abnormal
results are found in 15% of cases, and 1-2% have abnormalities that
require prompt action.
• When a renal US is performed in all children presenting with a UTI, 7%
will have an abnormal US warranting further investigations.

7.  Radionuclide scanning/MRI:
• Changes in dimercaptosuccinic acid (DMSA) clearance during acute UTI
indicate pyelonephritis or parenchymal damage, correlated with the
presence of dilating reflux and the risk of further pyelonephritis episodes,
breakthrough infections and future renal scarring.
• In the acute phase of a febrile UTI (up to four to six weeks), DMSA-scan
can demonstrate pyelonephritis by perfusion defects.
• Renal scars can be detected after three to six months.

8.  Voiding cystourethrography / urosonography:
• The optimum method to exclude or confirm VUR is VCUG.
• The timing of VCUG does not influence the presence or severity of
VUR.
• It is important to diagnose high-grade VUR after the first UTI since this
is an important risk for renal.
• physicians want to avoid unnecessary VCUG investigations at the
same time, given its invasive character and radiation burden.