3. Definition:-
• Invasion & multiplication of micro-organisms in the urinary system.
• Important cause of morbidity in children.
• Can cause renal damage if recurrent.
• Is often is associated with Vesico-ureteric reflux.
4. Incidence:-
• UTI occur in 1% of boys and 1-3% of girls.
• Newborn : M=F
Hematogenous spread
Cong. anomalies in males
• During the 1st yr of life,
• M:F is 2.8-5.4 : 1.
• More in uncircumscribed boys.
• Beyond 1 yr : F>M (10 : 1).
Ascending infection
5. Classification:-
A. On the basis of underlying defect:-
• Simple
• Complicated
B. On the basis of region involved:-
• Upper UTI - Pyelonephritis
• Lower UTI –Cystitis
C. Based on symptoms:-
• Symptomatic UTI
• Asymptomatic UTI
7. Causes:-
A. Bacteria:-
• E.coli (75 -90%)
• Proteus
• Klebsiella
• Staph. saprophyticus
• Pseudomonas
• Group B streptococcus
• H. Influenza
*Proteus and Pseudomonas infections occur following obstruction or instrumentation.
8. Causes:-
B. Virus:-
• Ebstein Barr
• Adeno virus
• HSV-2
C) Fungus:-
• Candida- immunocompromised children.
- after prolonged antimicrobial therapy
D) Parasites
9. Risk Factors
1.Host Factors:-
a) Stasis -Infrequent & Incomplete voiding
Constipation
Obstruction to flow-PUV, PUJ obstruction, stones
Ureterocele
Neurogenic bladder
b) Instrumentation
c) Malnutrition
10. Risk Factors
d) No circumcision
e) Length of urethra
f) Bubble bath
g) Toilet training
h) Pinworms
i) Indwelling catheter
j) Sexual activity
k) Pregnancy
2. Agent – organisms causing UTI.
11. Risk Factors
According to the 2011 AAP Guidelines for children 2-24 mon
• Risk factors for girls :-
• white race,
• age younger than 12 mon,
• temperature >39°C (102.2°F),
• fever for longer than 2 days, and
• absence of another source of infection.
• Risk factors for boys:-
• non-black race,
• temperature >39°C (102.2°F),
• fever for longer than 24 hrs, and
• absence of another source of infection.
20. Routine Examination of Urine
• Color- Hazy
• Smell- malodorous
• Pus cell >10/HPF (F) , >5 /HPF (M)
• RBC >5 /HPF
• RBC and WBC casts +
• Albumin – Trace to +
21. Urine C/S :-
1. >50,000 colonies of a single pathogen in suprapubic or catheter sample.
2. 10,000 colonies in the symptomatic child.
3. If the urinalysis result is positive, the patient is symptomatic, single
organism with a colony count >100,000.
4. If any of these criteria are not met, confirmation of infection with a
catheterized sample is recommended.
23. Renal scans
• DMSA renal scan – anatomy of kidney (Scarring)
• DTPA renal scan – Excretory function ,filtration function of kidney
• MAG 3 with lasix renal scan – Sensitive quantitative information regarding kidney
function and drainage , assesses the degree of blockage
24.
25. Principles of management
1. Treatment of acute infection
2. Prevention of further infection
3. Adequate investigation
4. Arrangement of further treatment
5. Follow up
26. Choice & route of Treatment
Usual indications for hospitalization for parenteral abx:-
• Age <1 months
• Clinical urosepsis or potential bacteremia
• Immunocompromised patient
• Complicated infection
• Vomiting or inability to tolerate oral medication
• Dehydrated
• Lack of adequate outpatient follow-up
• Failure to respond to outpatient therapy
• Most infants older than one months with simple UTI can be safely managed as outpatients if
follow-up is possible.
27. • Empiric antimicrobial therapy be initiated while awaiting culture results.
• If symptoms are mild and diagnosis is doubtful treatment can be awaited till c/s reports.
• The ultimate choice of antimicrobial therapy is based upon the sensitivities of the urine
culture isolate.
• The duration of treatment:- Complicated UTI : 10-14days.
Simple UTI : 7-10 days.
• Asymptomatic bacteriuria does not require treatment except in pregnant.
28. • Usually after 48-72 hrs, symptoms abate and oral intake improves and therapy is switched
to an oral antibiotics.
• Urine cultures should be repeated after 72 hours of therapy if the uropathogen is not
susceptible to the antibiotic that is being used for treatment or if susceptibility testing is
not performed.
• Asymptomatic bacteriuria do not require treatment.
• Routine alkalization of the urine is not necessary.
30. Prevention
1. General measures:-
• Fluid intake
• Complete and periodic voiding
• Vioding at bed time
• Perineal hyiene
• Treatment of worms
• Prevention of constipation
• Avoid catheterization
31. Prevention
• Early treatment of congenital anomalies
• Circumcision
2. Low dose chemoprophylaxis
• UTI until radiological evaluation is complete.
• Recurrent UTI (3 or more in a year).
• VUR grade I- III
• Post operative-PUJ,VUR grade IV & V, PUV
• Chronic cystitis
• Neurogenic bladder
32. Prevention
Commonly used drugs for prophylaxis:-
• Co-trimoxazole-2mg/kg/d
• Nalidixic acid-12.5mg/Kg/d
• Nitrofurantoin -1mg/kg/d
33. Follow up
1. Clinical-
• During the year following infection
• 1 year after starting prophylaxis
• height, Blood pressure –recorded
2. Urine C/S-
• 3 monthly-infancy
• Fever & symptoms –older children
3. RFT
4. Imaging –when needed
