Childhood Urinary Tract Infection

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Childhood Urinary Tract Infection
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Definition and classification

• It is an infection of both upper and lower
  urinary tract.
• Upper pyelonephritis, renal abscess.
• Lower cystitis , urethritis

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Epidemiology

• UTI is one of the most common bacterial
  infections of childhood.
• Affects up to 10 by the teenage years.
• Before age of 1 year boys girls 3 1
• After age of 1 year girls boys 10 1
• 40 of children with UTI will have anatomic or
  functional abnormalities of the urinary tract.
• e.g. reflux, malpositions, duplications,
  megaureter and hydronephrosis.

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Etiology

• Source of infection
• Mostly ascending.
• The bacteria arise from the fecal flora, colonize
  the perineum, and enter the bladder via the
  urethra
• In neonates HEMATOGENEUS.
• Etiological organisms
• Escherichia coli (80), Klebsiella and Proteus.
• Staphylococcus saprophyticus in adolesent girls.
• Viral infections (adenovirus), can cause
  cystitis.
• Fungal infections

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Risk Factors

• Type of patient
• -Female )short urethra)
• -Uncircumcised male.
• -Tight clothing.
• -Urethral instrumentation

• Abnormal Urinary tract
• -Vesicoureteral reflux.
• -Obstructive uropathy (major risk factor)
• Hydronephrosis
• -Neurogenic bladder

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Clinical Manifestations
Pyelonephritis Constitutional symptoms
Fever, malaise, chills.
Nausea, vomiting diarrhea.
Localizing symptoms
Abdominal or flank pain.
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Clinical Manifestations (cont)

• Cystitis
• Usually afebrile
• Dysurea
• Urgency
• Frequency
• Incontinence
• Hematuria
• Malodorous urine.
• Suprapubic pain tenderness.

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Clinical Manifestations (cont)
Urethritis -Dysurea -Reluctance to void -Perineal
discomfort, erythema -Vulval irritation
erythema (girls) -Urethral discharge in older
boys
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Symptoms of UTI Neonates infants
Change in urine color (or odor) as well as,
crying during micturation in an infant may be
noted by the mother.
BUT Nonspecific symptoms
Jaundice
Poor feeding
Irritability Weight
loss (or
poor weight gain)
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Asymptomatic bacteriurea

• Refers to individuals who have a positive
  urine culture without any manifestations of
  infection.
• Occurs almost exclusively in girls.
• This condition is benign and does not cause
  renal injury.

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Complications

• recurrance ( up to 25 to 40 )( follow up)
• bacteremia (more in infants)
• focal renal abscess ( uncommon )

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cont.
Acute pyelonephritis may result in renal injury
pyelonephritic scarring Hypertension If
recurrent scarring Chronic renal failure

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Diagnosis of UTI
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Diagnosis of UTI

• Suspect
• Symptoms
• Findings on urinalysis, or both.
• Confirm
• Urine culture.

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The diagnosis of UTI depends on having the
proper sample of urine
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Urine analysis
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• Urine microscopy
• Pus cells
• White cell cast
• RBCs ..
• Gram staining
• Urine dipstick
• - Leucocyte estrase
• - Nitrite

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Collecting the urine sample
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Collecting the urine sample

• In toilet-trained children
• midstream urine sample
• Satisfactory if
• The culture shows greater than 100,000 colonies
  of a single pathogen.
• There are 10,000 colonies and the child is
  symptomatic, it is considered a UTI.

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Collecting the urine sample (cont)

• In infants
• (1) Clean catch sample.
• (2) Urine collection bag.
• contamination is
  possible
• (3) In out urinary catheterization.
• (4) Suprapubic urine sample

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Notes about urine analysis culture

• Prompt plating of the urine sample is important
  - not more than one hour.
• A urinalysis should be obtained from the same
  specimen as that cultured.
• Pyuria (leukocytes in the urine) suggests
  infection, but infection can occur in the absence
  of pyuria.

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Treatment of UTI
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Treatment

• In acute febrile infections suggestive of
  pyelonephritis
• Parenteral treatment with ceftriaxone or
  ampicillin with gentamicin for 10-14 days.

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Treatment of UTI (cont)

• Acute cystitis
• Should be treated promptly to prevent its
  possible progression to pyelonephritis.
• trimethoprim-sulfamethoxazole .
• Nitrofurantoin for 3-5 days
• Amoxicillin
• If the symptoms are mild and the diagnosis is
  doubtful, treatment can be delayed until the
  results of culture are known, and the culture can
  be repeated if the results are uncertain

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FOLLOW UP

• We usually do urine culture 1 week after stopping
  of antibiotics then periodic reassessment for
  the next 1-2 years .

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Imaging Studies
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The goal of imaging studies in children with a UTI

• The goal of imaging studies in children with a
  UTI is to identify anatomic abnormalities that
  predispose to infection and to
• If there are any UTI complications

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Renal ultrasonogram
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Renal ultrasonogram

• hydronephrosis
• renal or perirenal abscesses
• Pyelonephritis
• renal scars ( 30)

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VCUG( MCUG)
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Voiding cystourethrogram (VCUG) Miturating
cystourethrogram (MCUG)

• Indications
• All children younger than 5 yr with a UTI,
• School-aged girls who have had two or more UTIs
• Any male with a UTI
• The most common finding is vesicoureteric reflux

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DMSA scan DTPA scan
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• DMSA scan
• Technetium-labeled
• Acute pyelonephritis
• Structural malformations of the kidney
• DTPA scan
• Dynamic study for
• Excretory Function
  
• Reflux

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DETPA
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Prevention of reccurrence of UTI
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Prevention of reccurrence of UTI

• Aderss and treat underlying cause.
• Manage constipation.
• Correct bottom wiping.
• Encourage drinking adequate fluid.
• Advice child not to delay voiding.
• Use of prophylactic antibiotics ..

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