1. URINARY TRACT INFECTION P R O T O C O LBY
AHMED SOLIMAN ABDELHALIM SOLIMAN ,MD
LECTURER OF PEDIATRICS
PEDIATRIC NEPHROLOGY &DIALYSIS UNIT
BENHA UNIVERISITY
EL HADA ARMED FORCES HOSPITAL ,TAIF, KSA
(LAST UPDATE NOVEMBER 2014)

2. BASICS INTRODUCTION It Is A Potential Serious Infection
The Highest Incidence In The First Year Of Life
It May Be Pyelonephritis Or Cystitis
The Commonest Error In The Management Of UTI In Children, And Especially In Infants, Is Failure To Establish Is The Diagnosis

3. BASICS Organisms Escherichia coli remains the predominant uropathogen.
Other organisms such as klebsiella , proteus and enterobacter species , staphylococci, and Streptococcus faecalis , GBS.
Hematogenous spread is common in newborns and infants in contrast to ascending infection in older children

4. E.COLI VIRULENCE FACTORS

5. BASICS
DEFINITIONS (CLASSFICATION)

6. CLINICAL APPROACH OF UTI

7. CLINICAL UTI APPROACH STEP 1 : HOW TO SUSPECT UTI ?
OCTOBER 2013
STEP 1 : HOW TO SUSPECT UTI ?
STEP2: HOW TO DIAGNOSE UTI (CULTURE)?
STEP 3 : IDENTIFY THE SITE OF UTI
STEP 4 : ANTIBIOTIC THERAPY FOR UTI
STEP 5 : WHAT IS THE UNDERLYING PATHOLOGY ?
STEP6: FOLLOW UP FOR RECURRENCE ?

8. STEP (1 ) :How to suspect UTI?
OCTOBER 2013
NICE guidelines recommend the testing of urine in infants and children with:
• Symptoms and signs of UTI.
• Unexplained fever of 38 ° C or higher
• An alternative site of infection but who remain unwell .

9. The gold standard for diagnosis of UTI is the urine culture.
STEP 2:Diagnosis
The gold standard for diagnosis of UTI is the urine culture.
Tests That Help Improve the Predictive Value of UTI
Presence of >10 white blood (HPF) (77%,89%)
Nitrate reductase test (50%,98%)
Leukocyte esterase test (84% ,78%)
The combination of leukocyte esterase and nitrite tests(72%,96%)

10. STEP2 : Diagnosis NICE recommended techniques
• Catheter sample or suprapubic aspiration (SPA),
method of choice in the severely ill infant under 1 year,
requiring urgent diagnosis and treatment, and in cases where
Alternatives (not NICE recommended)
An adhesive plastic bag (screening test).
midstream sample.

11. STEP3 :IDENTIFY SITE
Abdominal us (not sensitive)
DMSA (most senstive)
CT with contrast (risky)
MRI with contrast (expensive)

12. DMSA

13. CT (contrast)

14. MRI (contrast)

15. STEP 4:Treatment Age Pyleonephritis or cystitis General conditions
Choice of antibiotics
Doses of antibiotics .

16. NICE guidelines regarding antibiotic treatment 2007 are as follows
Below 3 months of age
Above 3 months of age
Pyleonephritis
Cystitis
Start parentral antibiotics for 2-4 days then oral for 10 days
start oral antibiotics for 7 days unless vomiting Start parentral antibiotics for 2-4 days then oral for 10 days
Oral antibiotics for 3 days

17. Treatment

18. Role out obstructive uropathy especially VUR
Step 5 :Identify underlying pathology
Role out obstructive uropathy especially VUR

19. Two attacks in less than 6 months Recurrence is seen in 30–50 %
Recurrent UTI
Two attacks in less than 6 months
Recurrence is seen in 30–50 %
The risk factors for recurrent UTI
Girls
Age <6 months
Phimosis/labial adhesions
Obstructive uropathy
Voiding dysfunction
Constipation
High-grade vesico-ureteral reflux (VUR)

20. Recurrent UTI :
VUR

21. Recurrent UTI Chemoprophylaxis “AAP 2013” Recurrent with VUR
Recurrent without VUR
evidence that prophylactic antibiotics prevent recurrent UTI in children
without VUR is weak.
Antibiotic prophylaxis may not be warranted in children with low-grade (grade I–II) VUR.
antibiotic prophylaxis may have a role in grade III–V VUR, especially in children <5 years of age

22. Recurrent UTI
Chemoprophylaxis choice

23. BENHA UNIVERISITY HOSPITALS PEDIATRIC NEPHROLOGY & DIALYSIS UNIT