1 / 11

Urinary Tract Infection In Children

Urinary Tract Infection In Children. Dr. Alia Al-Ibrahim Consultant Pediatric Nephrology Clinical Assistant Professor. Contents: 1- Definition of UTI 2- Etiology & pathogenesis 3- Predisposing Factors 4- Clinical presentations 5-Investigations 6- Management 7- Complications

cissy
Télécharger la présentation

Urinary Tract Infection In Children

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Urinary Tract Infection In Children Dr. Alia Al-Ibrahim Consultant Pediatric Nephrology Clinical Assistant Professor

  2. 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

  3. 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

  4. 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

  5. Clinical Presentation: 1- Upper UTI (Pyelonephritis). 2- Lower UTI ( Cystitis). The history & clinical coarse varies with the patient’s age & specific diagnosis.

  6. 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

  7. Urine analysis & dipstick:High index of suspicion for UTI in febrile children particularly those with unexplained fever. Lasts for 2-3days; • > 5 WBC/ hpf in centrifuged fresh urine positive screening test. • >Bacteria in cent. & non cent. Or phase contrast suggestible of UTI. • >Pyuria, proteinuria & Hematuria may occur with or without UTI. • >Nitrite concentrations & leukocyte estrase • POSITIVE URINE CULTURE IS ESSENTIAL FOR DIAGNOSIS OF UTI. • Urine culture: • Suprapubic : any number of colonies. • IN-and- out catheterization: > 10³. E.COLI • Midstream clean-catch urine collection > 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

  8. Management: • < 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 < 5 yrs • Male: • 1- No signs: oral antibiotics • 2- US, MCUG

  9. COMPLICATIONS: 1- VUR 2- Scarring 3- HTN 4- Renal insufficiency. VUR Normal DMSA Acute Pyelonephritis Scarring

  10. 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

  11. 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.

More Related