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    Urinary Tract Infections in Children

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    Alvin Omondi
    Urinary tract infections are common in children and can lead to renal scarring if not treated properly. Diagnosis requires culture of a properly collected urine sample. Treatment involves antibiotics for 7-10 days to eliminate the infection. Children under 6 months or those with atypical or recurrent UTIs should undergo imaging to identify structural abnormalities and vesicoureteral reflux which increase risk of permanent kidney damage. With appropriate diagnosis, treatment and follow up, most children will have no long term consequences from UTIs.

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    Urinary Tract Infections in Children

    Uploaded by

    Alvin Omondi
    50 views31 pages
    Urinary tract infections are common in children and can lead to renal scarring if not treated properly. Diagnosis requires culture of a properly collected urine sample. Treatment involves antibiotics for 7-10 days to eliminate the infection. Children under 6 months or those with atypical or recurrent UTIs should undergo imaging to identify structural abnormalities and vesicoureteral reflux which increase risk of permanent kidney damage. With appropriate diagnosis, treatment and follow up, most children will have no long term consequences from UTIs.

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    UTI[1]

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    Urinary tract infections are common in children and can lead to renal scarring if not treated properly. Diagnosis requires culture of a properly collected urine sample. Treatment involves antibiotics for 7-10 days to eliminate the infection. Children under 6 months or those with atypical or recurrent UTIs should undergo imaging to identify structural abnormalities and vesicoureteral reflux which increase risk of permanent kidney damage. With appropriate diagnosis, treatment and follow up, most children will have no long term consequences from UTIs.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    50 views31 pages

    Urinary Tract Infections in Children

    Uploaded by

    Alvin Omondi
    Urinary tract infections are common in children and can lead to renal scarring if not treated properly. Diagnosis requires culture of a properly collected urine sample. Treatment involves antibiotics for 7-10 days to eliminate the infection. Children under 6 months or those with atypical or recurrent UTIs should undergo imaging to identify structural abnormalities and vesicoureteral reflux which increase risk of permanent kidney damage. With appropriate diagnosis, treatment and follow up, most children will have no long term consequences from UTIs.

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    of 31

    URINARY TRACT

    INFECTIONS IN
    CHILDREN
    What is a Urine Tract Infection??
    • Urine tract infection is colonisation by bacteria in any part
    of the urinary tract
    • It is a common bacterial infection in children
    • Associated with high morbidity
    Urine tract
    WHY DO WE NEED TO
    DISCUSS URINE TRACT
    INFECTIONS IN
    CHILDREN????
    Significance of UTI
    • permanent renal scarring
    • There is a 10- 15% risk of developing kidney scarring after UTI
    • The risk increases with every subsequent UTI
    but a small minority will

    The vast bulk of children with urinary


    tract
    infections will suffer no serious sequelae
    Background
    • Epidemiology
    • Incidence
    • All newborns 0.1-1% (LBW newborns up to 10%)
    • Under 6 months
    • Preschool: greater in females
    • School age: 30-fold greater in females
    • Prevalence
    Females Males
    < 1yr 7% 3%
    > 1yr 8% 2%
    Overall < 21yr 9 – 15%
    Background
    • Classification
    • Asymptomatic bacteruria
    • Cystitis (Lower UTI)
    • Pyelonephritis (Upper UTI/Complicated cystitis)
    • Route of Infection
    • Hematogenous spread (neonates)
    • Ascension of bacteria migrating from GI tract (beyond infancy)
    Background
    • Predisposing factors
    • Obstructive uropathy (e.g. Posterior urethral valves)
    • Vesicourethral reflux (VUR)
    • Voiding disorders
    • Renal calculi
    Background
    • Risk Factors
    • Male
    • Uncircumcised <1yr (4-10 times greater risk than in the circumcised)
    • All less than 6 months
    • Family history of VUR or renal disease
    • Constipation
    • History suggestive of previous UTI or confirmed previous UTI
    • Recurrent fever of uncertain origin
    • Immunodeficiency
    • Sexual activity (particularly in females)
    Suspecting a UTI
    Non-specific clinical findings particularly in infants and children less than 3 years
    AGE GROUP SYMPTOMS AND SIGNS

    Most common Least common


    Infants younger than 3 months Fever Poor feeding Abdominal pain
    Vomiting Failure to thrive Jaundice
    Lethargy Hematuria
    Irritability Offensive urine
    Infants & children Preverbal Fever Abdominal pain Lethargy
    3 months or older Loin tenderness Irritability
    Vomiting Hematuria
    Poor feeding Offensive urine
    Failure to thrive
    Verbal Frequency Dysfunctional Fever
    Dysuria voiding Malaise
    Changes to Vomiting
    continence Hematuria
    Abdominal pain Offensive urine
    Loin tenderness Cloudy urine
    Clinical features
    • Younger children the signs are a little ambiguous
    – Fever may be the only symptom
    – Vomiting
    – Abdominal pains
    – Foul smelling urine
    – Irritability
    – Poor feeding
    • So it is important to have a high index of suspicion in
    children
    Suspecting a UTI
    • High index of suspicion in a febrile child will lessen the
    number of UTIs missed
    • Urinalysis recommended in all febrile children without a focus of
    infection (prevalence 5%)
    Study in KNH on febrile children had prevalence of about
    10%
    Diagnosis
    Diagnosis of UTI requires culture
    of an appropriately collected urine
    sample
    Bag specimen
    • Clean genitalia with
    clean water
    • Remove immediately
    after micturition
    • Unacceptable for
    culture -only good for
    screening sensitivity
    good poor
    specificity 70%
    • If positive (dipstix leuc
    or nitrite) then send
    another specimen
    using other collection
    method
    Suprapubic Puncture
    ‘In and out catheter’:girl
    ‘In +out catheter’:boy
    Diagnosis
    • Urine culture
    • No element of urinalysis or combination of elements of urinalysis is
    as sensitive and specific as a culture of an appropriately collected
    sample.-SPA or trans urethral catheterisation
    Diagnosis
    • Indications for culture
    • Age under 3 years with no other focus of infection
    • Suspected acute pyelonephritis/upper UTI
    • Positive dipstick or urinalysis
    • Recurrent UTI
    • A high to intermediate risk of serious illness
    • Infection not responding to treatment within 24 –48 hours (if not
    already taken)
    • Clinical symptoms and dipstick tests do not correlate
    Microscopy
    • Diagnosis of UTI confirmed or excluded based on
    the number of colony-forming units (cfu). The
    higher the concentration of organisms the more
    reliable the results
    • SPA: any growth
    • Catheter: > 10,000 cfu/ml
    • CCM: > 100,000 cfu/ml
    Treatment
    • Goals
    • Relieve acute symptoms
    • Eliminate infection and prevent urosepsis
    • Prevent recurrence and long-term complications
    Treatment
    Treat a child with a presumptive UTI with antibiotics after
    obtaining an appropriate sample for culture
    Any of the following are suggestive
     Positive nitrite screen
     Positive nitrite and LE screen
     Positive microscopic examination pyuria and bacteruria
    Prompt treatment reduces severity of renal scarring
    • Antibiotics
    • Infants less than 3 months
    • Upper UTI – parenteral antibiotics for 7 days
    • Children more than 3 months
    • Upper UTI/Lower UTI – oral antibiotics 7-10 days unless the child is
    septic and cannot tolerate orally
    • Has not been shown that any mode of antibiotic
    therapy is superior to another. Oral therapy equally
    effective.
    Outpatient treatment
    First line
    Cefuroxime
    Amoxi-clav

    Alternatives
    3rd generation cephalosporin
    In Patient Treatment
    • Cefuroxime
    • Ceftriaxone
    • Aminoglycosides

    • Alternatives
    • Ampicillin + sulbactam
    • Ceftazidime
    Treatment
    Infants who do not respond to antimicrobial therapy within
    two days should undergo ultrasonography promptly and
    either voiding cystourethrography or radionuclide
    cystography at the earliest convenient time.
    Diagnostic Imaging
    • Goal
    • Identify structural abnormalities of urinary tract or
    bladder and VUR
    • General recommendations
    • All children < 6months
    • Children > 6 months
    • Atypical UTI
    • Recurrent UTI
    Investigation - definitions
    Atypical UTI Recurrent UTI
    • seriously ill • 2 or more episodes of UTI with
    • septicaemia acute pyelonephritis / upper
    • poor urine flow urinary tract infection
    • 1 episode of UTI with acute
    • raised creatinine
    pyelonephritis / upper urinary
    • abdominal or bladder mass tract infection + 1 or more
    • failure to respond to treatment episodes of UTI with cystitis /
    with suitable antibiotics within lower urinary tract infection
    48 hours • 3 or more episodes of UTI with
    • infection with non- E. Coli cystitis / lower urinary tract
    organisms infection
    Prevention of recurrence
     Constipation should be addressed in infants
    and children who have had a UTI.
     Children who have had a UTI should be
    encouraged to drink an adequate amount.
     Children who have had a UTI should have
    ready access to clean toilets when required
    and should not be expected to delay voiding
    Summary
    • Diagnosis of UTI: bag specimen only for screening use
    dipstick
    • Clean catch, in out catheter or suprapubic catheter and
    send for microscopy culture
    • Treat the UTI appropriately
    • Investigations only of true UTI based on culture unless
    confounders
    • In our setting start with ultrasound KUB
    • Refer these children early and appropriately

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