Childhood Urinary Tract Infection

Definition and classification

It is an infection of both upper and lower
urinary tract.
Upper : pyelonephritis, renal abscess.
 Lower : cystitis , urethritis

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.
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
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
Clinical Manifestations
Pyelonephritis
Constitutional symptoms:
Fever, malaise, chills.
Nausea, vomiting ± diarrhea.
Localizing symptoms:
Abdominal or flank pain.
Clinical Manifestations (cont)
Cystitis
Usually afebrile
 Dysurea
 Urgency
 Frequency
 Incontinence
 Hematuria
 Malodorous urine.
 Suprapubic pain & tenderness.
Clinical Manifestations (cont)
Urethritis
-Dysurea
-Reluctance to void
-Perineal discomfort, erythema
-Vulval irritation & erythema (girls)
-Urethral discharge in older boys
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)
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.

Complications
recurrance ( up to 25% to 40% )( follow
up)
 bacteremia (more in infants)
 focal renal abscess ( uncommon )

cont.
Acute pyelonephritis may result in renal
injury
“pyelonephritic scarring”
Hypertension
If recurrent scarring
Chronic renal failure
Diagnosis of UTI
Diagnosis of UTI
Suspect:
Symptoms
Findings on urinalysis, or both.
Confirm:
Urine culture.
The diagnosis of UTI depends on
having the proper sample of urine
Urine analysis
 Urine microscopy:
Pus cells
White cell cast ………
RBCs ……..
Gram staining
 Urine dipstick:
- Leucocyte estrase
- Nitrite
Collecting the urine
sample
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.
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
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.
Treatment of UTI
Treatment
 In acute febrile infections suggestive of
pyelonephritis:
 Parenteral treatment with ceftriaxone
or ampicillin with gentamicin for 10-14
days.
Treatment of UTI (cont):
Acute cystitis:
 Should be treated promptly to prevent its
possible progression to pyelonephritis.



trimethoprim-sulfamethoxazole .
Nitrofurantoin
Amoxicillin
for 3-5 days
 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
FOLLOW UP

We usually do urine culture 1 week after
stopping of antibiotics ; then periodic
reassessment for the next 1-2 years .
Imaging Studies
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
Renal ultrasonogram
Renal ultrasonogram
-
-
hydronephrosis
renal or perirenal abscesses
Pyelonephritis
renal scars ( 30%)
VCUG( MCUG)
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
DMSA scan & DTPA scan
DMSA scan:
Technetium-labeled
Acute pyelonephritis
Structural malformations of the
kidney
DTPA scan:
Dynamic study for:
Excretory Function
Reflux
DETPA
Prevention of reccurrence of UTI
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
…………..
THANK YOU