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

1. UTI in children
Department of paediatrics
Benazir bhutto hospital Rawalpindi
DR.ABDULREHMAN ,HOUSE OFFICER

2. Introduction
• Prevalence and etiology:
• Urinary tract infection occur in 1-3 % of girls and 1% of boys
• In girls ,uti usually occur by age of 5 year,with peak incidence
during infancy and toilet traning
• In boys ,most utis occur during 1 year of life ,utis are much
more common in uncirucmscribed boys ,especially in 1 year of
life
• About 2.5 % percent of school age girls will have a uti,80% of
these patients experiences a recurrence .

3. Defination
UTI is defined as the culture of pure growth of organisms >105
organisms /ml of urine sample ,in presence of symptoms
Classification :based on involment of renal parenchyma
(pyelonepritis )or the bladder (cystitis )
Pyelonephritis :involvement of renal parenchyma ,if there is no
involve ment the conditon may termed as pyelitis

4. Continue…
• Characterized by abdominalback or flank pain ,fever
,malaise,nausea,vomiting and occasionally diarrhae, fever may
be the only manifestion .
• Cystitis : indicates if there is bladder involvement
characterized by dysuria ,urgency,frequency,suprapubic pain
,incontinence and malodorous urine

5. ANATOMY OF URINARY
TRACT

6. ETIOLOGY
• COMMON ORGANISMS ARE:
ESCHERICHIA COLI(80-90%)
KLEBSIELLA (1-3%)
PROTEUS (0.5%0
STAPHYLOCOCCOUS SAPROPHYTICUS
PSEUDOMONAS

7. RISK FACTOR FOR URINARY
TRACT INFECTION
UNCIRCUMCISED MALE TIGHT CLOTHING
FEMALE GENDER PINWORM INFESTATION
VESICOURETERAL REFLUX (35% OF
CHILDREN)
ANATOMIC ABNAORMILITY
TOILET TRAINING NEUROPATHIC BLADDER
VOIDING DYSFUNCTION
OBSRUROUCTIVE UROPATHY
URETHERAL INSTRUMENTTION
WIPING FROM BACK TO FRONT

8. SINGN AND SYMPTOMS
• CLINICAL FINDINGS :VARIES WITH AGE
• NEWBORN :MAY PRESENT WITH FEVER ,HYPOTHERMIA ,POOR FEEDING
,JAUINDICE VOMITING ,FAILURE TO THRIVE OR SEPSIS
• PRE SCHOOL CHILDREN :ABDOMINAL PAIN VOMITING SRONG
SMELLING URINE, FEVER, ENURESIS,DYSURIA ,INCREASE FREQUENCY
OF URINATION ,OR URGENCY
• School age children: may develop the classical signof uti including
enuresis,increased frequency of urination dysuria ,urgency ,fever
and costoverteberal angle tenderness
• Not all symptoms of uti actualylprove to be realated to bacterial
infection .anatomic abnormalities,voiding discomfort or irritation of
external genitalia may be the replica of uti

9. Diagnostic procedures
• Complete urine examination:
• The presence of pyuria (>5 wbc /hpf ) is suggestive of uti but
specimen collection is important
• Conversely active uti may present without any pus cell in 50%
percent of cases
• Pyuria along with white cell cast is suggestive of infection

10. Continue ….
• Urine culture :diagnosis must be based on urine culture
• Count of 10 5 cfu for single organism is accepted as a proof of
infection althogh countof 10 4 should not be discounted as
contaminant .follow up culture should be obtained at least 72
hours after start of antimicrobial therapy

11. Continue….
• Nitrate sticks :non culture methods such nitrates sticks for
early detection of uti
• Imaging :ultrasonography should be performed to search for
obstruction or urinary tract anamolies .it can be repeated
serially to monitor the renal growth
• MCU:identifies vesicoureteral reflux and establish the degree
of reflux

12. Continue…
• Renal function test:may be mildly elevated in case of renal
paranchyma involvement

13. Content taken from research gate portal present on pubmed

14. Accuracy of different test in
dianosis of uti
Data taken research article published in pubmed

15. Management
After confirmation of uti (cystitis) initial therapy should be based
on patient history of antibiotics use,location of infection and drug
sesivities:
If treatment is initiated before the result of culture and senivities
are avaliable ,a 3-5 course of therapy with (TMP_SMX) 8mg /kg in
two divided doses is effective against most strains of e.coli.

16. Continue….
• Nitrofurantoin 5-7mg /kg/day in 3-4 divided doses is also
effective and has advantage of being activeagainst klebsiella
and enterobacter organisms
• Amoxicillin (20-50 mg /kg )In 3 divided doses Is also effctive as
a initial treatment but no clear advantage over sulfonamides
or nitofurantoin

17. CONTINUE …
• For complicated infection antibiotic course may be prolong to
10-14 days ,the choice of antibiotic therapy must be
confirmed by prior culture and Sensivities testing
• Moreover supportive therapy include antipyretics and high
fluid intake is recommended

18. Outpatient management

20. PREVENTIVE STRATGIES
• Risk factor for uti should be investigated and eliminated
INCLUDING :
• OBSTRUCTIVE UROPATHIES
• HYGIENE (WIPING FROM BACK TO FRONT )
• REFLUX RELATED UTI
• RECURRENCETUTI USAUALLY REQUIRED PROPHYLAXIS (IN
CASE OF VUR AND OTHER URINARY TRACT ANAMOLIES)

21. Prophylactic doses

22. COMPLICATIONS
• HYPERTENSION
• RENAL SCARRING
• SEVERE VESICOURETERAL REFLUX
• CHRONIC RENAL FAILURE

23. FOLLOW UP AND
MONITORING
• All children should be closely folowed up in case of having
their first uti to prevent the recurrence every 1-2 month by
urine culture untill they remained free of infection for 1 year

25. PROGNOSIS
• PROGNOSIS IS EXCELLENT IF RENAL INVOLVEMENT HAS NOT
TAKEN PLACE
• ONCE INFECTION HAS PROGRESSED TO RENAL PARANCHYMA
PROGNOSIS FALLS .
• EVERY EFFORT SHOULD BE MADE TO PREVENT RECURRENCE

26. CASE SECENRIO
• A 26 DAY OLD MALE BABY PRESENTED WITH COMPLAINT OF
REDUCE FEEDING INTAKE HAVING FEVER OF 101F ,FAILURE TO
THRIVE .ON EXAMINATION CHILD IS FEBRILE TO TOUCH
,JAUINDICE AND LETHARGIC .INITIAL INVESTIGATION SHOWS
• CBC :ELEVATED WBC COUNT
• INFLAMMATORY MARKERS :ELEVATED
• URINE R/E :SHOWS PYURIA HAVING WBC COUNT OF 12WBC
/HPF
• URINE C/S SHOWS GROWTH OF E.COLI AT CULTURE MEDIA
AFTER 48 HOUR
• RFT :UNREMARKABLE
• LFT :UNRMARKABLE
•

27. CASE SCENERIO 2
2A 2 YEAR OLD FEMALE CHILD PRESENTED TO your clinic with
complaint of EPISODES of vomiting ,FREQUENT URINATION
,STRONG SMELLING URINE.mother gave history of use of
antibiotics prescribed by a local practioner 2 days ago ON
EXAMINATION CHILD IS dehydrated by,aFEBRILE TO TOUCH
INITIAL INVESTIGATION SHOWS:
ELEVATED WBC COUNT
DIFFERNTIAL LEUKOCYTE SHOWS MARKED NEUTROPHILIA
URINE R/E shows significant pyuria and wbc cast
Urine c/s shows no growth on culture
You remarks ??what is marked pyuria ?why there is no growth
on culture despite pyuria ?

28. Case scenrio 3
• A school going child presented to you with hx of painful micturation
,increased frequency of urination , vomiting , and flankpain
• On examination child is febrile ,costovertebal angle tenderness
positive and mildly dehydrated
• Mother also gave hx of 3 previous episodes in one year and
• Investigation shows
• Increased TLC count
• Urine r/e shows pus cell
• Urine c/s shows growth of e.coli
• Imaging shows marked hydroneprosis and decreased paranchymal
volume
• Other investigation unremarkable
• Remarks ????