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![Urinary Tract Infections
Dr. Kalpana Malla
MD Pediatrics
Manipal Teaching Hospital
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Urinary Tract Infections
This document summarizes urinary tract infections (UTIs). It defines UTIs as the invasion and multiplication of microorganisms in the urinary system, including the urethra, bladder, and kidneys. UTIs are classified based on the infected region (upper vs lower tract), symptoms (symptomatic vs asymptomatic), and underlying defects (simple vs complicated). The most common causes are Escherichia coli and other gram-negative bacteria. Risk factors include female anatomy, prior instrumentation, age, and genetic predispositions. Symptoms vary based on the infected region and age. Diagnosis involves urine testing and culture. Treatment consists of antibiotics while prevention focuses on general hygiene and sometimes long-term antibiotic pro
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Urinary Tract Infections
- 1. Urinary Tract Infections Dr. Kalpana Malla MD Pediatrics Manipal Teaching Hospital Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
- 2. UTI • Definition:- Invasion & multiplication of micro- organisms in the urinary system – any component of the urinary tract including • Urethritis • Cystitis • Pyelonephritis
- 3.
- 4. UTI - Classification:- A.On the basis of underlying defect simple complicated B. Based on symptoms Symptomatic UTI Asymptomatic UTI
- 5. Classification C. On thebasis of region involved - Upper UTI - pyelonephritis - Lower UTI – Cystitis - Urethritis
- 6. Incidence:- • Newborn :M=F Hematogenous spread Cong. anomalies in males • >1 yr : F>M Ascending infection **Overall 1% boys & 3 % girls have UTI in 1st decade
- 7.
- 8. Etiology - Microorganisms A. Bacteria:- • Gram negative bacteria • - Escherichia coli (80 %- 90 %) • - Klebsiella • - Proteus (30%) • Gram positive bacteria • - Enterobacter • - Citrobacter. • - Staph saprophyticus • - Group B streptococcus - H. Influenza • - Staph. Aureus
- 9. Etiology - Lesscommon B. Virus:- Ebstein Barr Adenovirus enteroviruses Coxsackie viruses echoviruses C) Fungus - Candida spp., Aspergillus spp. Cryptococcus neoformans D) Parasite
- 10. Risk Factors 1.Host Factors:- a) Stasis -Urinary obstruction - infrequent & incomplete voiding - Constipation - Obstruction to flow-PUV,PUJ obs,stones,ureterocele - Neurogenic bladder - Vesicoureteral reflux
- 11. Host Factors:- b) Instrumentation c)Malnutrition d) Age/ Sex e )Uncircumcised boys f )Race/ethnicity g )Genetic factors h) Length of urethra i) Urine itself j) DM
- 12. Risk Factors 2. Agent-organism 3.Size of inoculum- small/large
- 13. PATHOGENESIS • Ascending infectionmost UTI beyond the newborn period • Descending infection 4 - 9 percent of children with UTI are bacteremic
- 14.
- 15. Presentations < 2 month- nonspecific symptoms and signs – fever , Jaundice 2month -1 year:- Fever/Hypothermia Vomiting, Diarrhea Sepsis Irritability Lethargy Malodorous urine
- 16. Presentations 1-5 years:-Abdominal pain-Flank /back/ Supra pubic - Vomiting ,diarrhea - Constipation - Abnormal voiding - Urgency, urinary incontinence, dysuria
- 17. 1-5 years - MalodorousUrine - Fever/febrile convulsion - Failure to thrive
- 18. Presentations >5years:-Dysuria Frequency Urgency Abdominal discomfort Fever Malodorous urine
- 19. Physical examinations • Temperature • Pallor • Anthropometry • Blood pressure • Tenderness-Lower abdomen • Renal angle • Renal mass • Palpable bladder
- 20. Physical examinations • Fecal mass • Signs of valvitis • Spine • Lower limb reflexes • Associated with UTI-Prune belly syndrome Anorectal anomalies
- 21. Localizing symptoms: Symptoms ofurethritis: • Dysuria • Reluctance to void • Perineal discomfort • Vaginal irritation and erythema in girls • In older boys, urethral discharge • In adolescent girls associated with PID symptoms
- 22. Localizing symptoms: Features ofcystitis: • Afebrile usually • Frequency • Enuresis • Dysuria • Reluctance to void
- 23. Localizing symptoms: Featuresof pyelonephritis: • Fever and systemic signs • Older children – Flank pain or abdominal pain • Younger children – Fever, irritability, vomiting, poor feeding
- 24. LABORATORY EVALUATION Dipstick Microscopy Culture & sensitivity
- 25. Investigations Methods of urinecollection • Clean catch or midstream sample • Supra pubic aspiration –infancy • Urinary bag sample –small children • Catheter specimen –Severely ill
- 26. LABORATORY EVALUATION Urine dipstick 88 % sensitive • Leukocytes • Protein • Red blood cells • Leukocyte esterase • Nitrite
- 27. LABORATORY EVALUATION Microscopic exam •Bacteria: bacteriuria is the presence of any bacteria per hpf. • Gram stain
- 28. Routine Microscopic Examination •Color-Hazy • Smell- malodorous • White Blood Cells: pyuria is defined as ≥5 WBC/PHF in centrifused or ≥10 WBC/mm3 in an uncentrifuged sample • Bacteria: bacteriuria is the presence of any bacteria per hpf. - Gram stain
- 29. Routine Microscopic Examination •RBC >5 /HPF • RBC+WBC casts+ • Albumin –Trace to + Urine C/S- gold standard - should be processed as soon as possible after collection
- 30. LABORATORY EVALUATION Urine culture • Midstream clean catch > 10⁵ colony forming units (girls) > 104 CFU (boys) • Catheterization 10⁵ CFU • Supra pubic aspiration any growth
- 31. LABORATORY EVALUATION Other laboratory tests • Investigate the fever – CBC, CRP • Serum creatinine • Blood culture — Bacteremia occurs in 4-9 % of infants with UTI • Lumbar puncture — Infants <1 month of age with fever and a positive urinalysis; approximately 1 % of infants with UTI also have meningitis
- 32. Imaging studies 1.Radiological –MCU IVP X-ray KUB 2. Nuclear- USG DMSA scan DTPA scan MAG scan
- 33. Renal scans • DMSArenal scan – anatomy of kidney (Scarring) • DTPA renal scan – Excretory function ,filtration function of kidney • MAG 3 with lasix renal scan – Obstruction at the ureterovesical junction - quantitative information regarding kidney function and drainage , assesses the degree of blockage
- 34. Principle of management 1. Treatment of acute infection 2. Prevention of further infection 3. Adequate investigation 4. Arrangement of further treatment 5. Follow up - Prevention of recurrence and long-term complications
- 35. MANAGEMENT Indication for hospitalize: •Age <2 months • Sepsis or potential bacteremia • Immunocompromised patient • Vomiting or inability to tolerate oral medication • Lack of adequate outpatient follow-up • Failure to respond to outpatient therapy
- 36. Choice & routeof Treatment Depends on – Age Severity of illness Choice of agent: provide adequate coverage for E. coli.
- 37. ANTIBIOTIC THERAPY: • Newborn + Infants Inj ampicillin + Inj. Gentamycin-14 days • Older children:- Oral – Co-timoxazole cephalosprins Nalidixic acid amoxicillin-clavulanate • Parenteral therapy: Ampicillin or Third- or fourth- generation cephalosporins and aminoglycosides - first-line agents for empiric treatment of UTI in children.
- 38. MANAGEMENT ANTIBIOTIC THERAPY • Durationof therapy: 7-14 days • Response to therapy: Clinical response Repeat urine culture
- 39. Indications for further investigations: 1. Girls younger than 3 years with a first UTI 2. Boys of any age with a first UTI 3. Children of any age with a febrile UTI 4. Children with recurrent UTI 5. First UTI in a child of any age with a family history of renal disease, abnormal voiding pattern, poor growth, hypertension
- 40. Prevention 1. General measures:- •Fluid intake • Complete and periodic voiding • Vioding at bed time • Perineal hyiene • Treatment of worms • Prevention of constipation • Avoid catheterization
- 41. Prevention • Early treatmentof cong anomalies • Circumcision 2. Low dose chemoprophylaxis - UTI until radiological evaluation is complete - Recurrent UTI - VUR grade I- III - Post operative-PUJ,VUR IV & V, PUV
- 42. Prevention - Chronic cystitis - Neurogenic ladder Commonly used drugs for prophylaxis:- • Co-trimoxazole-2mg/kg/d • Nalidixic acid-12.5mg/Kg/d • Nitrofurantoin -1mg/kg/d
- 43. Follow up 1. Clinical- During the year following infection 1 year after starting prophylaxis height, Blood pressure –recorded 2. Urine C/S- 3 monthly-infancy Fever & symptoms –older children 3.RFT 4. Imaging –when neded
- 44. Thank you Download moredocuments and slide shows on The Medical Post [ www.themedicalpost.net ]
Editor's Notes
- #27 convenient, inexpensive, and require little training
- #28 convenient, inexpensive, and require little training
- #32 approximately 30 percent of children with a normal CRP have pyelonephritis
- #38 Second- and third-generation cephalosporins (eg, cefprozil, cefpodoxime, cefixime, cefotaxime, ceftriaxone) and aminoglycosides (eg, gentamicin, amikacin) are appropriate first-line agents for empiric treatment of UTI in children. However, these drugs are not effective in treating Enterococcus and should not be used for patients in whom enterococcal UTI are suspected (eg, those with a urinary catheter in place, instrumentation of the urinary tract, or an anatomical abnormality). In such patients, amoxicillin or ampicillin should be added.