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UTI B.pptx
- 1. Urinary tract infectionin children
- 2. Introduction The urinary tractis a common site of infection in the pediatric population.Unlike the generally benign course of urinary tract infection (UTI) in the adult population. UTI in the pediatric population is well recognized as a cause of acute morbidity and chronic medical conditions, such as hypertension and renal insufficiency in adulthood.
- 3. As a result,it is crucial to have a clear understanding of the pathogenesis of UTI, risk factors, indications for diagnostic tests, and the appropriate uses of antimicrobial agents in the management of children with UTI.
- 4. The urinary tract(ie, kidney, ureter, bladder, and urethra) is a closed, normally sterile space lined with mucosa composed of epithelium known as transitional cells. The main defense mechanism against UTI is constant antegrade flow of urine from the kidneys to the bladder with intermittent complete emptying of the bladder via the urethra.
- 5. This washout effectof the urinary flow usually clears the urinary tract of pathogens The urine itself also has specific antimicrobial characteristics, including low urine pH, polymorphonuclear cells, and Tamm Horsfall glycoprotein, which inhibits bacterial adherence to the bladder mucosal wawall
- 6. UTI occurs whenthe introduction of pathogens into this space is associated with adherence to the mucosa of the urinary tract. If uropathogens are cleared inadequately by the washout effect of voiding, then microbial colonization potentially develops.
- 7. Colonization may befollowed by microbial multiplication and an associated inflammatory response. Bacteria that cause UTI in otherwise healthy hosts often exhibit distinctive properties—known as virulence factors
- 8. Urinary tract infections(UTIs) occur in 1% of boys and 1-3% of girls. T he prevalence of UTIs varies with age. During the 1st yr of life, the male : female ratio is 2.8-5.4 : 1. Beyond 1-2 yr, there is a female preponderance, with a male : female ratio of 1 : 10.
- 9. • Bacterial infectionsare the most common. • E coli is the most common causing 75-90% of UTI episo des. Other bacteria include: • Klebsiella species • Proteus species • Enterococcus species • Staphylococcus saprophyticus • Adenovirus (rare) • Fungal in immune compromised patients Etiology
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- 11. CLINICAL MANIFESTATIONS ANDCLASSIFICATION The 3 basic forms of UTI are:- .1 Pypyelonephritis .2 Cystitis, and .3 Asymptomatic bacteriuria.
- 12. Clinical Pyelonephritis Clinical pyelonephritisis characterized by any or all of the following: – abdominal, back, or flank pain; – fever; malaise; nausea; vomiting; and, – occasionally, diarrhea. – Fever may be the only manifestation.
- 13. Newborns can shownonspecific symptoms such as poor feeding, irritability, jaundice, and weight loss. Pyelonephritis is the most common serious bacterial infection in infants younger than 24 mo of age who have fever without an obvious focus
- 14. These symptoms arean indication that there is bacterial involvement of the upper urinary tract. Acute pyelonephritis can result in renal injury, termed pyelonephritic scarring.
- 15. Cystitis Cystitis indicates thatthere is bladder involvement symptoms include:- dysuria, urgency, frequency, suprapubic pain, incontinence, and malodorous urine
- 16. Cystitis does notcause fever and does not result in renal injury. Malodorous urine is not specific for a UTI.
- 17. Asymptomatic Bacteriuria Asymptomatic bacteriuriarefers to a condition in which there is a positive urine culture without any manifestations of infection. • It is most common in girls • The incidence is <1% in preschool and schoolage girls and is rare in boboy • This condition is benign and does not cause renal injury, except in pregnant women, in whom asymptomatic bacteriuria, if left untreated, can result in a symptomatic UTI.
- 18. Diagnosis • The definitive diagnosisof a UTI requires the isolation of at least one uropathogen from a urine culture • Urine, which should be obtained before the initiation of antimicrobial therapy, can be collected by various methods.
- 19. • The AAP recommendssuprapubic aspiration or urethral catheterization to establish a diagnosis of UTI in neonates and young children. • Aclean-catch specimen may be obtained from older children and young adults.
- 20. Urinalysis: – A urinespecimen that is found to be positive for nitrite, le ukocyte esterase, or blood may indicate a UTI. – Microscopic examination can evaluate presence of WBCs ( >5 per high-power field), RBCs, bacteria, casts, and skin co ntamination (e.g., epithelial cells).
- 22. TREATMENT Acute cystitis – 3- to5-day course of therapy with trimethoprim-sulfamethoxazole (TMP-SMX) trimethoprim is effective against many strains of E. coli.
- 23. Nitrofurantoin (5-7 mg/kg/24 hr in 3-4 divided doses) also is effective and has the advantage of being active against Klebsiella and Enterobacter organisms. Amoxicillin (50 mg/kg/24 hr) also is effective as initial treatment but has a high rate of bacterial resistance.
- 24. Pyelonephritis In acute febrileinfections suggesting a 7-14 day course of broad-spectrum antibiotics capable of reaching significant tissue levels is preferable.
- 25. Indication for admission Childrenwho are :- dehydrated, vomiting, unable to drink fluids, 1 mo of age or younger, have complicated infection, in whom urosepsis is a possibility admitted to the hospital for IV rehydration and IV antibiotic therapy.
- 26. Reurrent UTI: Two ormore UTIs over a six months period. There will be a period of remission followed by a recurrence of the infection Causes: Inadequate treatment either due to compliance or improper prescription. unrecognized site of bacterial persistence such as small infected calculus o un recognized anatomic abnormality.