Urinary Tract Infection In Children

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Urinary Tract Infection In Children
Dr. Alia Al-Ibrahim Consultant Pediatric
Nephrology Clinical Assistant Professor
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Contents 1- Definition of UTI 2- Etiology
pathogenesis 3- Predisposing Factors 4- Clinical
presentations 5-Investigations 6- Management 7-
Complications 8- Special problems in UTI
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UTI in Children
Definition Presence of bacteria in urine
along with symptoms of infection. Incidence 5
in Girls 1-2 in Boys During the 1st yr of
life more common in boys, after age of one more
in girls Etiology Most common infecting
pathogen Escherichia Coli 80 of UTI. Other
pathogens - Staphylococcus Streptococcus
Species -
Enterobacteria ( Klebsiella, Proteus,
pseudomonas) -
Occasionally Candida albicans
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Route of infection Neonate Hematogenous Later
Ascension of bacteria into the Urinary
tract. Development of UTI depend on 1-
Virulence of the invading bacteria. 2-
Susceptibility of the host. Predisposing
factors 1- Conditions lead to urinary stasis
renal calculi, Obstructive Uropathy , VUR,
Voiding disorder. 2- Immune deficiency 3- Broad-
spectrum antibiotics ( amoxicillin,
cephalexin). 4- constipation 5- uncircumcised
male
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Clinical Presentation 1- Upper UTI
(Pyelonephritis). 2- Lower UTI ( Cystitis). The
history clinical coarse varies with the
patients age specific diagnosis.
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• 0-2months sepsis
• 2mon-2yrs unexplained fever
• irritability, poor oral
  intake, abdominal pain, vomiting, loose
• bowel movement.
• voiding symptoms of cystitis
• crying on urination
• smelly urine
• no fever or mild
• 2yrs
• Pyelonephritis( fever, irritability,
  poor appetite, abdominal flank
• pain back
  pain, voiding symptoms, tenderness in
• 
  costovertebral angle or flank.
• cystitis voiding symptoms (
  urgency, frequency, hesitancy, dysuria,
• urinary incontinence)
• mild or no fever,
  Suprapubic or abdominal pain

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• Urine analysis dipstickHigh index of suspicion
  for UTI in febrile children particularly those
  with unexplained fever. Lasts for 2-3days
• gt 5 WBC/ hpf in centrifuged fresh urine positive
  screening test.
• gtBacteria in cent. non cent. Or phase contrast
  suggestible of UTI.

• gtPyuria, proteinuria Hematuria may occur with
  or without UTI.
• gtNitrite concentrations leukocyte estrase
• POSITIVE URINE CULTURE IS ESSENTIAL FOR DIAGNOSIS
  OF UTI.
• Urine culture
• Suprapubic any number of colonies.
• IN-and- out catheterization gt 10³.
  E.COLI
• Midstream clean-catch urine collection gt 10,000
• Single organism
• 2 or more contamination.
  E.COLI
• Blood culture neonate infant
• Pyelonephritis CBC neutrophlic leukocytosis
  
• high ESR
• C-reactive protein.
  Proteus
  Pseudomonas
• Distinction between upper lower difficult in
  children

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• Management
• lt 5 yrs
• With systemic signs
• 1- Iv antibiotics shift to oral after
  improvement , duration 10 -14 days.
• 2- US , renal cortical scintigraphy ( DMSA) ,
  MCUG.
• No systemic signs
• 1- oral antibiotics for 7-10 days
• US, MCUG( if indicated)
• 5 yrs
• Female
  Female Male with signs
• 1- no signs oral antibiotics
  Like lt 5 yrs
• Male
• 1- No signs oral antibiotics
• 2- US, MCUG

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COMPLICATIONS 1- VUR 2- Scarring 3- HTN 4- Renal
insufficiency.
VUR
Normal DMSA
Acute Pyelonephritis
Scarring
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Special problems 1-Reurrent UTI Two or more
UTIs over a six months period. Causes
Inadequate treatment. unrecognized
site of bacterial persistence such as small
infected calculus or un
recognized anatomic abnormality. 2-VUR
Abnormal backwash of urine into ureter or
kidney Radiological evaluation VCUG, Isotope
cystogrm
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• 3-Breakthrough UTI
• Caused by
• 1- change in the resistance pattern of organisms
  colonizing the
• urethra.
• 2- noncompliance.
• 3- VUR
• 4- Voiding dysfunction.
• 4-Voiding dysfunction
• Detrusor instability incomplete bladder
  emptying
• Associated with daytime enuresis constipation.
• Increase risk of UTI VUR.
• RX 1- Timed voiding
• 2- Treatment of constipation.
• 3- Prophylactic antibiotics.
• 4- Anticholinergic medications.
• 5-Asymptomatic bacteruria
• No need for antibiotics, low risk of scarring.