Scleroderma: Treatment Options and a Look to the Future - Dr. Macklin
Urinary Tract Infections
1. Urinary Tract Infections
Dr. Kalpana Malla
MD Pediatrics
Manipal Teaching Hospital
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2. UTI
• Definition:-
Invasion & multiplication of micro-
organisms in the urinary system
– any component of the urinary tract including
• Urethritis
• Cystitis
• Pyelonephritis
11. Host Factors:-
b) Instrumentation
c) Malnutrition
d) Age/ Sex
e )Uncircumcised boys
f )Race/ethnicity
g )Genetic factors
h) Length of urethra
i) Urine itself j) DM
23. Localizing symptoms:
Features of pyelonephritis:
• Fever and systemic signs
• Older children
– Flank pain or abdominal pain
• Younger children
– Fever, irritability, vomiting, poor feeding
28. Routine Microscopic Examination
• Color-Hazy
• Smell- malodorous
• White Blood Cells: pyuria is defined as ≥5
WBC/PHF in centrifused or ≥10 WBC/mm3 in
an uncentrifuged sample
• Bacteria: bacteriuria is the presence of any
bacteria per hpf. - Gram stain
29. Routine Microscopic Examination
• RBC >5 /HPF
• RBC+WBC casts+
• Albumin –Trace to +
Urine C/S- gold standard
- should be processed as soon as
possible after collection
31. LABORATORY EVALUATION
Other laboratory
tests
• Investigate the fever – CBC, CRP
• Serum creatinine
• Blood culture — Bacteremia occurs in 4-9 %
of infants with UTI
• Lumbar puncture — Infants <1 month of age
with fever and a positive urinalysis;
approximately 1 % of infants with UTI also have
meningitis
33. Renal scans
• DMSA renal scan – anatomy of kidney
(Scarring)
• DTPA renal scan – Excretory function ,filtration
function of kidney
• MAG 3 with lasix renal scan – Obstruction at
the ureterovesical junction - quantitative
information regarding kidney function and
drainage , assesses the degree of blockage
34. Principle of management
1. Treatment of acute infection
2. Prevention of further infection
3. Adequate investigation
4. Arrangement of further treatment
5. Follow up - Prevention of recurrence and
long-term complications
35. MANAGEMENT
Indication for hospitalize:
• Age <2 months
• Sepsis or potential bacteremia
• Immunocompromised patient
• Vomiting or inability to tolerate oral
medication
• Lack of adequate outpatient follow-up
• Failure to respond to outpatient therapy
36. Choice & route of Treatment
Depends on – Age
Severity of illness
Choice of agent: provide adequate coverage
for E. coli.
37. ANTIBIOTIC THERAPY:
• Newborn + Infants
Inj ampicillin + Inj. Gentamycin-14 days
• Older children:-
Oral – Co-timoxazole
cephalosprins
Nalidixic acid
amoxicillin-clavulanate
• Parenteral therapy: Ampicillin or Third- or fourth-
generation cephalosporins and aminoglycosides
- first-line agents for empiric treatment of UTI in
children.
39. Indications for further
investigations:
1. Girls younger than 3 years with a first UTI
2. Boys of any age with a first UTI
3. Children of any age with a febrile UTI
4. Children with recurrent UTI
5. First UTI in a child of any age with a family
history of renal disease, abnormal voiding
pattern, poor growth, hypertension
40. Prevention
1. General measures:-
• Fluid intake
• Complete and periodic voiding
• Vioding at bed time
• Perineal hyiene
• Treatment of worms
• Prevention of constipation
• Avoid catheterization
41. Prevention
• Early treatment of cong anomalies
• Circumcision
2. Low dose chemoprophylaxis
- UTI until radiological evaluation is complete
- Recurrent UTI
- VUR grade I- III
- Post operative-PUJ,VUR IV & V, PUV
43. 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 neded
44. Thank you
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Editor's Notes
convenient, inexpensive, and require little training
convenient, inexpensive, and require little training
approximately 30 percent of children with a normal CRP have pyelonephritis
Second- and third-generation cephalosporins (eg, cefprozil, cefpodoxime, cefixime, cefotaxime, ceftriaxone) and aminoglycosides (eg, gentamicin, amikacin) are appropriate first-line agents for empiric treatment of UTI in children. However, these drugs are not effective in treating Enterococcus and should not be used for patients in whom enterococcal UTI are suspected (eg, those with a urinary catheter in place, instrumentation of the urinary tract, or an anatomical abnormality). In such patients, amoxicillin or ampicillin should be added.
![Urinary Tract Infections
Dr. Kalpana Malla
MD Pediatrics
Manipal Teaching Hospital
Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ]](https://image.slidesharecdn.com/renal-urinarytractinfections-120105055910-phpapp01/85/Urinary-Tract-Infections-1-320.jpg)
