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Urinary Tract Infections in Children

Epidemiology Urine samping

Female predominance Midstream
Clean catch
Complications Catheterisation
Permanent scarring of kidney Bag samples (contamination rate ↑ with longer application)
Sepsis
Hypertension Investigations
Renal failure Urine microscopy (gram stain)
Pyuria No Pyuria
Bacteriology Phimosis wash out Still can be UTI
Enterobacteriaceae Vaginal wash out Leukopaenia
E coli Glomerulonephritis
Klebsiella, Enterobacter, Citrobacter, Proteus, Providencia, Morgenella, Febrile illnesses
Serratia, Salmonella Dip sticks
Pseudomona s species Leukocyte esterase – 88-95% sensitivity pyuria
Pseudomonas Nitrites – less sensitive, less specific
Gram +ve species Cultures
Staphylococcus Positive (>૚૙૞ CFU/mL) Positive (<૚૙૞ CFU/mL)
Enterococcus UTI/ (contamination) Contamination
UTI
Virulence Factors Frequent voiding
Enhance colonisation ↓ Urinary pH
Aid in persistence in urinary tract ↑ Fluid intake
Capacity for inflammation Mixed Growth No Growth
Adherence (Hydrophobic, Electrostatic, Receptors ) Contamination No infection
Motility (Flagellae) UTI may present/ not present Infection but organism has not
Bacterial survival enhanced UTI with > 1 organism (rare) grown
(K-antigen, Proteins enhancing Fe uptake, Complement resistance)
Damage to tissues (Haemolysins, Colicine) Therapy Antibiotic Therapy
Normal Hygiene IV or Oral
Host Defence Factors Normal Voiding Habits Duration
Mechanical Treat Constipation 1 dose for Cystitis
Hydrodynamic Treat Worm Infestation Longer for PN, Infants, Pregnant
Anti-adherent Drinking Habits Antibiotic of Choice
Receptor dependant Trimetoprim
Immunologic Cotrimoxazole
Nitrofurantoin (Nalidixic acid)
Pathogenesis 2nd or 3rd generation Cephalosporins
Ascending Descending (Not ampi- or amoxicillin)
Infants
Perinephric abscess Investigations
Ultrasound
Perineal/ Urethral Factors VUR (Not most reliable method)
Phimosis/ non -circu mcision Presence of 2 kidneys
Short urethra (Female) Exclude obstruction
Bubble bath, Wiping techniques Measure kidneys
Hygiene Bladder residual volume post micturation
1st UTI at 0-2 y/o
Pinworms
Prophylaxis antibiotics Ultrasound
+/- 6 weeks after infection MCU (Boys)
Bladder Factors
Isotope Cystography (Girls)
Infrequent voiding
DMSA
Incomplete voiding
1st UTI at 2-7 y/o
Neurogenic bladder VUR a bit ↓ common Ultrasound
Constipation, Encopresis MCU might be traumatic DMSA
If 1st UTI no scar, unlikely for next UTI If abnormal, MCU/ Isotope
Upper Urinary Tract to scar cystography
Vesico-ureteral Reflux Obstruction 1st UTI > 7 y/o
50% of children with UTI Pelvi-Ureteric Junction Ultrasound
Residual urine post micturition Vesico-Ureteric Junction (Urodynamics on indi cation)
Posterior Urethral Valves If all Investigations –ve
Ectopic ureters +/- Ureterocoeles Stop antibiotic prophylaxis
Examine urine (at every febrile episode, whenever child unwell)
Clinical Presentation Quick response to eventual new UTI
Infants Lower tract symptoms If VUR present
Irritability Urgency Depend on
Poor feeding Frequency • Degree of reflux
Failure to gain weight Enuresis • Presence & extend of renal scarring
Vomiting, Diarrhoea Dysuria • Discuss with surgeon
Jaundice (late onset) Vulvitis • Expected compliance
Fever Bubble bath irritation Conservative treatment
Urethritis Surgery
Voiding dysfunction
Asymptomatic Cystitis Pyelonephritis
↑ grade Fever
Flank pain/ tenderness
↑ WBC, ESR, CRP