UTI in paediatric age group is a very imp.topic .

UTI in children

1. URINARY TRACT INFECTIONS Presented by: Kamana Bhandari Intern – SBH Department of Pediatrics

2. OBJECTIVES Introduction Forms of UTI in children Diagnosis of UTI Treatment of UTI Complications

3. Urinary tract infection is defined as invasion of the urinary tract by pathogenic organisms which may involve the upper and lower urinary tract. DEFINITION

4. One of the commonest infections in children, 3-10% in girls and 1-3% in boys Important cause of morbidity and might result in renal damage, often in association with vesicoureteric reflux (VUR). During infancy, UTIs are equally common in boys and girls Beyond infancy, incidence of UTI - higher in girls. EPIDEMIOLOGY

5. Escheria coli Klebsiella Enterobacter Staphylococcus epidermidis Proteus Pseudomonas Candida ETIOLOGIC ORGANISMS

6. Female sex Age below 6 months Obstructive uropathy Vesicoureteric reflux Bowel and bladder dysfunction (e.g., chronic constipation) Repeated catheterization Immunocompromised states Kidney stones Habitual postponement of voiding (voiding dysfunction) RISK FACTORS

7. Upper UTI Cystitis High grade fever Toxic look Nausea Vomiting Abdominal pain (flanks) Diarrhea Dysuria Urgency Frequency Suprapubic pain Hematuria Usually no/mild fever SYMPTOMS

8. 0-2 months Features of sepsis Fever, Vomiting, Diarrhea, Jaundice, Poor weight gain, Lethargy. Older infants Fever, Frequent micturition and occasionally Convulsions. Presence of crying or straining during voiding, dribbling, weak or abnormal urine stream and palpable bladder- Suggest urinary obstruction SYMPTOMS

9. Complicated Presence of fever >39 °C Persistent vomiting Dehydration Renal angle tenderness Raised creatinine level Simple Low grade fever Dysuria, frequency, and urgency Simple vs complicated UTI

10. History taking: History of prior UTI, Presence of risk factors for UTI CBC: WBC counts high in upper UTI Serum Creatinine Screening - Urine microscopy- leukocytes Rapid Dipstick tests- leukocyte esterase and Nitrite(moderate sensitivity and specificity) Definitive diagnosis: urine culture DIAGNOSIS

11. Urine culture – Gold standard DIAGNOSIS Method of collection Colony count Suprapubic aspiration Any number of pathogens Urethral catheterization >5 × 10 4 CFU/mL Midstream clean catch >10 5 CFU/mL

12. <3 months of age and those with complicated UTI- hospitalized, parenteral antibiotics Ceftriaxone/ Cefotaxime / Amikacin/ Gentamicin Others- oral therapy- Cefixime / Cephalexin/ Amoxy-clav / Ciprofloxacin TREATMENT

13. Duration of treatment Infants and children with complicated UTI- 10- 14 days Uncomplicated UTI- 7-10 days Adolescents with cystitis- 3 days Supportive measures- hydration, emptying bladder frequently to prevent stasis Urine culture- Sterile by 24-36 hrs. of appropriate therapy- if failure- lack of bacterial sensitivity to medications or presence of underlying urinary tract anomalies TREATMENT

14. Investigation < 1 yr 1-5 yr 5 yr Investigation < 1 yr. 1-5 yr. >5 yr. USG + + + DMSA + + Only if USG abnormal MCU + Only if any of the above is abnormal Culture proven UTI- Follow up

15. Bowel and bladder dysfunction Structural abnormalities of the urinary tract- VUR, PUV(posterior urethral valve), Duplex ureter Constipation Catheterization Worm infestation Alteration of peri -urethral flora by antibiotic therapy Risk factors of Recurrent UTI

16. Adequate fluid intake Frequent voiding Constipation must be avoided Circumcision Antimicrobial prophylaxis: single bedtime Cotrimoxazole, Nitrofurantoin, Cephlaexin , Cefadroxil PREVENTION

17. Retrograde flow of urine from bladder to ureters and pelvis at rest or during micturition. 40-50% infants and 30-50% children with UTI Primary and Secondary VUR Primary VUR (E.g. Congenital abnormal ureter) Secondary VUR- Bladder outflow obstruction, as with posterior urethral valves, neurogenic bladder or a functional voiding disorder VUR

18. Classification- based on MCU appearance-Grade I to V- I to III- Low grade, IV and V- High grade VUR Grades

19. Grade I and II: Antibiotic prohylaxis till 1 year old Grade III to V: Antibiotic prohylaxis till 5 year old. Continue beyond 5 years, if bowel bladder dysfunction present. SiYMPTOMS Low grade VUR- subsides spontaneously High grades- need surgical repair TREATMENT

20. OP Ghai Essential of Pediatrics Textbook PDF Download, 9 th edition REFERENCES