1. Childhood Urinary Tract Infection

2. Definition and classification
It is an infection of both upper and lower urinary tract.
Upper : pyelonephritis, renal abscess.
Lower : cystitis , urethritis

3. 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.

4. Etiology Source of infection: Etiological organisms: 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

5. 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

6. Clinical Manifestations
Pyelonephritis
Constitutional symptoms:
Fever, malaise, chills.
Nausea, vomiting ± diarrhea.
Localizing symptoms:
Abdominal or flank pain.

7. Clinical Manifestations (cont)
Cystitis
Usually afebrile
Dysurea
Urgency
Frequency
Incontinence
Hematuria
Malodorous urine.
Suprapubic pain & tenderness.

8. Clinical Manifestations (cont)
Urethritis
-Dysurea
-Reluctance to void
-Perineal discomfort, erythema
-Vulval irritation & erythema (girls)
-Urethral discharge in older boys

9. 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)

10. 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.

11. Complications recurrance ( up to 25% to 40% )( follow up)
bacteremia (more in infants)
focal renal abscess ( uncommon )

12. cont. Acute pyelonephritis may result in renal injury
“pyelonephritic scarring”
Hypertension
If recurrent scarring
Chronic renal failure

13. Diagnosis of UTI

14. Diagnosis of UTI Suspect: Confirm: Symptoms
Findings on urinalysis, or both.
Confirm:
Urine culture.

15. The diagnosis of UTI depends on having the proper sample of urine

16. Urine analysis

17. Urine microscopy:
Pus cells
White cell cast ………
RBCs ……..
Gram staining
Urine dipstick:
- Leucocyte estrase
- Nitrite

18. Collecting the urine sample

19. 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.

20. 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

21. 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.

22. Treatment of UTI

23. Treatment In acute febrile infections suggestive of pyelonephritis:
Parenteral treatment with ceftriaxone or ampicillin with gentamicin for days.

24. Treatment of UTI (cont):
Acute cystitis:
Should be treated promptly to prevent its possible progression to pyelonephritis.
trimethoprim-sulfamethoxazole .
Nitrofurantoin for 3-5 days
Amoxicillin
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

25. FOLLOW UP
We usually do urine culture 1 week after stopping of antibiotics ; then periodic reassessment for the next 1-2 years .

26. Imaging Studies

27. 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

28. Renal ultrasonogram 28

29. Renal ultrasonogram hydronephrosis renal or perirenal abscesses
Pyelonephritis
renal scars ( 30%)

30. VCUG( MCUG)

31. 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

32. DMSA scan & DTPA scan

33. Structural malformations of the kidney DTPA scan:
DMSA scan:
Technetium-labeled
Acute pyelonephritis
Structural malformations of the kidney
DTPA scan:
Dynamic study for:
Excretory Function
Reflux

35. DETPA

36. Prevention of reccurrence of UTI

37. 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 …………..

38. THANK YOU