URINARY TRACT
INFECTION IN CHILDREN
OBJECTIVES
Why is UTI in children important?
Is it a common problem?
How are we protected from UTI?
How do children with UTI present?
What are the common organisms
that cause UTI?
How do you confirm the diagnosis?
How do you manage a child with a
UTI?
UTI in Children
Carriesrisk of renal damage
Recognition difficult
non specific symptoms
esp. in infancy
Diagnosis difficult
Often associated with congenital
abnormalities of renal tract
Congenital Abnormalities of
Renal Tract
Accounts for 17% of antenatally
diagnosed abnormalities
Obstetric U/S scan increased
recognition of urinary tract
abnormalities
Congenital abnormalities
contd
Diverse anatomical spectrum
renal anomalies
pelviureteric anomalies
ureterovesical junction
abnormalities
duplex systems
anomalies of bladder and urethra
UTI
Occurs in
3-5% of girls
1% of boys
Girls first UTI upto 5yrs
peaks during infancy & toilet
training
Boys majority in 1 st yr of life
commoner in uncircumcised
boys
1st yr male:female = 2.8:5.4
After 2yrs male:female = 1:10
Normal Defences in the Urinary
Tract.
Washout mechanism-regular urine
formation.
Adequate hydration
Regular complete emptying of
bladder
IgA content of transitional epithelium
Breakdown of Defence
Mechanisms.
Incomplete emptying of bladder.
Urinary stasis
Outflow
obstruction Faulty
bladder
VUR or bowel
habits
Aetiology
Neonate - Haematogenous or via
urethra
Older children - Ascending
infection
Clinical Manifestations.
Asymptomatic
Symptoms not related to
urinary tract
Classical symptoms of UTI
Neonates
Poor feeding
Flattening of wt. curve.
Prolonged jaundice.
Fever/ Septicaemia
1 month - 3 years
Fever
Abdominal pain
vomiting
Failure to thrive
Macroscopic Hturia - rarely
Symptoms less severe
in.
Repeated infections
Recurrence close to an earlier
infection
AT ALL AGES - POSSIBILITY OF
SEXUAL ABUSE MUST BE
CONSIDERED
Urinary Pathogens
NORMAL BOWEL COMMENSALS
90% E. coli
Klebsiella aerogenes- often in
newborns
Proteus mirabilis
Enterococcus faecalis
Pseudomonas species
Staph. albus
Diagnosis
Should be considered in any sick
infant
ACCURATE DIAGNOSIS
ESSENTIAL.
UTI - presence of actively
multiplying organisms in
the urinary tract.
Only valid criterion for diagnosis-
demonstration of a significant no.
of bacteria in the urine.
Urine Culture
A colony count of 105 or more of
a single organism in a properly
collected and transported sample
of urine is diagnostic.
Urine Collection
Collecting bag.
Clean catch/ mid stream sample.
Supra pubic bladder puncture.
Catheter specimen.
Storage and Transport
Urine - good culture medium.
No multiplication of organisms at 40
c
Urine Microscopy
W.B.C. in urine sign of
inflammation (bacterial/
nonbacterial)
Repeated urine microscopy in
patients with UTI -W.B.C. count
varies from normal- gross pyuria
A NORMAL W.B.C COUNT DOES
NOT EXCLUDE A UTI
Urine Microscopy
Uncentrifuged fresh sample of urine
Advantages
Tentative diagnosis in an acutely ill
patient, before culture report is available.
Suggests renal involvement if WBC casts
present.
In boys under 4 yrs. - aids diagnosis when
urine cultures get contaminated with
preputial bacteria
Management
Establish diagnosis
Treatment of acute presenting
infection, without delay
Investigate to exclude renal tract
anomalies
Relief of obstruction/prevention of
further infection if VUR present
Follow up as appropriate
Treatment
Siteof infection upper tract,
lower tract, recurrent UTI,
atypical UTI
Age - < 3mths, > 3mths
Symptomatic/not
Choice of drug
Treatment oral
iv
Prophylaxis
Duration of treatment
Treatment contd...
Other measures
control of fever
fluid intake
prevent constipation
bladder emptying
Investigations
Current recommendation
All children <3yrs need U/S after
the 1st episode of UTI
Other investigations if indicated
plain xray abd
DMSA/IVU
DTPA
MCUG
U/S Scan
Non invasive
Excluding obstruction
assess solid /cystic masses
Bladder capacity & residual urine
Renal size & volume
BUT
Driver dependent
Cannot assess function
Unreliable in detecting
1. renal scars 2. VUR
U/S SCAN ALONE IS NOT
SUFFICIENT TO EXCLUDE
URINARY TRACT PATHOLOGY
MCUG
Visualisesbladder, bladder
neck,& urethra.
Demonstrates VUR
DMSA SCAN
Functional image of kidney based
on tubular activity.
Demonstrates renal scars.
Differential renal function.
DTPA SCAN
Dynamic scan
Estimates GFR
Demonstrates obstruction
The ultimate goal of
management of UTI in
children is to prevent
progressive renal scarring
with its consequences
Hypertension
Pproteinuria
Complications of pregnancy
Renal failure
