PEDIATRIC URINARY TRACT INFECTION PRESENTATION.pptx

This PPt is on pediatric urinary tract infections

1. PEDIATRIC URINARY TRACT INFECTION SUPERVISOR : Dr JACOB TUBADI NKUNA

2. Learning Objectives Differentiate between upper and lower UTIs in children Interpret urinalysis and urine cultures accurately Select appropriate antibiotic therapy Collaborate with an inter professional team for complex UTIs

3. Introduction UTI is one of the most common bacterial infections in children Can involve any part of urinary tract: urethra → bladder → kidneys Prompt diagnosis & treatment prevent morbidity and renal damage Requires optimized urine collection and imaging studies

4. Classification of UTIs Lower tract UTI → urethritis, cystitis Upper tract UTI → pyelonephritis, ureteral infection Asymptomatic bacteriuria = bacteria present without symptoms Sterile pyuria = WBCs present without bacterial growth

5. Complicated UTIs UTIs in newborns Urosepsis Congenital anomalies of kidneys/urinary tract (CAKUT ) Non–E. coli organisms, atypical clinical course, renal abscess

6. Etiology E . coli → 85–90% of pediatric UTIs Other organisms : Klebsiella , Proteus, Enterococcus , Enterobacter Proteus spp → linked with renal stone formation Pseudomonas, GBS, Staph. aureus → often with CAKUT or catheter use

7. Epidemiology 8.4 % of girls, 1.7% of boys have UTI before age 7 Incidence peaks: infancy, toilet training, early sexual activity (girls ) Uncircumcised male infants <3 months → 20% risk Circumcised male infants → 2.4% risk

8. Risk Factors Female sex, younger age, white race Uncircumcised infant boys Vesicoureteral reflux (VUR ) Bowel and bladder dysfunction (BBD ) Indwelling bladder catheters, immunodeficiency, kidney stones

9. Pathophysiology Frequent urine flushing = main defense Uropathogenic E. coli → special virulence factors (fimbriae, toxins ) Adherence prevents bacterial clearance Constipation & bladder dysfunction increase UTI risk

10. Clinical Presentation (Infants) Fever , vomiting, poor feeding, irritability Jaundice, hypothermia, failure to thrive Symptoms often nonspecific Fever without source is the most common sign

11. Clinical Presentation (Older Children) Dysuria , frequency, urgency Hematuria, suprapubic pain Flank pain, fever, abdominal pain → pyelonephritis Cloudy or foul-smelling urine

12. Physical Examination Abdominal distension or palpable bladder Costovertebral angle tenderness (pyelonephritis ) Palpable stool (constipation ) Hydronephrosis or flank mass in severe cases

13. Urine Collection (Non-toilet trained) Methods : bag, catheterization, suprapubic aspiration Bag specimens: for urinalysis only, not culture Catheterization: quick, low contamination, painful Suprapubic aspiration: gold standard but rarely used

14. Urine Collection (Older children) Midstream clean-catch sample preferred Proper cleaning of genital area essential Retract foreskin gently in uncircumcised boys Store urine within 1 hr (room temp) or 4 hrs (refrigerated)

15. Urinalysis Interpretation Leukocyte esterase (LE): marker of WBC activity/CBC Nitrites: indicate gram-negative bacterial presence Microscopy: WBC >5/ hpf or bacteria = UTI Blood/protein on dipstick not reliable

16. Urine Culture Criteria ≥ 100,000 CFU/mL (midstream specimen ) ≥50,000 CFU/mL (catheterization ) ≥1,000 CFU/mL (suprapubic aspiration ) Must correlate with symptoms & urinalysis findings Blood culture , electrolytes, urea and creatinine

17. Imaging Studies Renal ultrasound: first-line for structural anomalies.( normal,hydronephrosis,dilated uretres , renal increase echogecity , thickening of wall bladder,etc ). VCUG(voiding cystouretrogram ): only if recurrent UTI or abnormal ultrasound. DMSA scan: gold standard for renal scarring.

18. Empiric Antibiotic Therapy Start after UA, before culture results Oral antibiotics: 2nd/3rd gen cephalosporins , amoxicillin- clavulanate Avoid nitrofurantoin for pyelonephritis (poor tissue penetration ) Parenteral therapy for infants <2 months or severe cases

19. Antibiotic Duration Infants/toddlers <24 months or pyelonephritis: 7–14 days Older children with cystitis: 3–7 days Pyelonephritis: IV (2–4 days) → oral (10–14 days total ) Asymptomatic bacteriuria: no treatment (except pregnancy)

20. Recurrent UTI Definition : ≥2 UTIs in 6 months OR ≥3 in 1 year Risk factors: VUR, BBD Renal ultrasound + VCUG for recurrent cases Prevention: hydration, timed voiding, constipation management

21. Antibiotic Prophylaxis Indications : VUR grade III+ VUR with recurrent UTI VUR with BBD Any VUR in non-toilet-trained children TMP-SMX: preferred option Nitrofurantoin: for sulfa allergy Amoxicillin: infants <2 months

22. Surgical Options For persistent VUR with breakthrough infections Endoscopic injection ( Deflux ®) for lower-grade VUR Ureteric reimplantation (open/laparoscopic/robotic) for high-grade VUR Goal: prevent renal scarring and preserve function

23. Differential Diagnosis Urethritis , cystitis, pyelonephritis. Viral infection, renal stones. Orchitis , epididymitis, STIs. Appendicitis, pelvic infections.

24. Prognosis Most children recover fully without renal damage. Follow-up urine cultures not routinely required. Risk of complications higher in neonates & immunocompromised. Early recognition & treatment = best outcomes.

25. Complications Acute : dehydration, electrolyte imbalance, AKI, urosepsis . Chronic: renal scarring, reflux nephropathy. Long-term risks: proteinuria, hypertension, CKD, ESRD. Bilateral renal scarring → dialysis or transplant . NB : posterior urethra valve common emergency consultations Do not routinely give antibiotics I UTI

26. ANY QUESTION MERCI