A video by:
Dr. Bharat Kc (MBBS 2014, BPKIHS)

Urinary Tract Infection in Children
Dr. Shankar Prasad Yadav
MD Pediatrics, FPN (IPNA, SJMCH)
Assistant Professor
BPKIHS

Overview of presentation
Definition
Epidemiology
Etiopathogenesis
Clinical features and classification
Diagnosis
management
Follow up

6 mo/m with refusal of feeds, irritability and fever for 5 days


Urine R/E: 5-6 wbc/hpf
Urine C/S: E. coli, 105 CFU/ml

Treatment: Syp. Ritocef X 7 days on opd basis

Did we completely managed the child

Why is the diagnosis of UTI important in children?
UTI may bring to attention a child with an obstructive anomaly or severe VUR.
Risk factor for AKI
Long-term complications of UTI
-renal scarring
-hypertension
-chronic renal failure

Epidemiology
Third most common bacterial infection in children

Sypmtomatic UTI below 14 years
1-2% boys
3-8% girls

Urinary tract abnormalities in evaluated UTI
30-40%

In investigated UTI
Obstructive malformation
Girls - 2% Boys - 10%

VUR
Girls - 36% Boys - 24%

UTI: growth of a significant number of organisms of a single species in the urine, in the presence of symptoms

In girls: Escherichia coli(75%-90%) ,Klebsiella spp. and Proteus sps.
Boys more than 1 yr: Proteus = E. coli
Others: Staphylococcus saprophyticus and enterococcus
Viruses: Adenovirus-11, 21

Clinical features
Neonates
Lethargy
Refusal to feed
Neonatal cholestasis
Hypothermia/ hyperpyrexia
Features of septicemia

Infants
Unexplained Fever
Persistent diarrhea
Vomitings

Older children
Burning micturition
Crying during micturition
Fever
Flank pain
Urgency
Frequency

Simple UTI
Low grade fever
Dysuria
Urgency
Frequency

Complicated UTI
High fever (more than 39 F)
Systemic toxicity
Vomiting, dehydration
Renal angle tenderness
Raised Creatinine

INVESTIGATIONS
Urine analysis

Urine culture

Dipstick tests: leukocyte esterase and nitrite test.

Ultrasound

MCUG

DMSA scan

How to collect urine for culture
Wash the genitals with soap water
Collect mid stream clean catch urine in a sterile container
Cover with a lid
Promptly process- plating within one hour
If delay is expected, store in refrigerator at 4˚C for 12-24 hours
In neonates and infants: per urethral catheterization or suprapubic aspiration
Urine collection bag: NOT RECOMMENDED!!

Timing of USG, MCU and DMSA
USG should be done soon after diagnosis of UTI.
MCU is recommended 2-3 weeks later
DMSA scan is carried out 2-3 months after treatment.

An early DMSA scan, performed soon after a UTI, is not recommended in routine practice.
Patients showing hydronephrosis in the absence of VUR should be evaluated by diuretic renography (DTPA)

Measures to reduce recurrent UTI
Perineal hygiene
Attention to under-garments and, foreskin in boys
Cleaning of perineum from anterior to posterior direction
Plenty of fluid intake and frequent voiding
Treat constipation
Deworming
Toilet trained children with VUR
Regular low pressure voiding with complete bladder emptying
Double voiding
Recurrent breakthrough infections
Double prophylaxis with cotrimoxazole and nitrofurantoin
Role of circumcision

Antibiotic prophylaxis
First UTI below 1 year of age, while awaiting imaging studies
VUR
Grades I and II
Antibiotic prophylaxis until 1 yr old. Restart antibiotic prophylaxis if
breakthrough febrile UTI.

Grades III to V
Antibiotic prophylaxis up to 5 yr of age. Consider surgery if breakthrough febrile
UTI.

Beyond 5 yr: Prophylaxis continued if there is bowel bladder dysfunction.

Frequent febrile UTI (3 or more episodes in a year) even if the urinary tract is normal
Given as single oral night dose
Cotrimoxazole: 1-2 mg/kg/day of TMP: Avoid in less than 3 months, G6PD deficiency
Nitrofurantoin: 1-2 mg/kg/day: nausea/vomiting, avoid in less than 3 mo, G6PD deficiency and insufficiency
Cephalexin: 10mg/kg/day: DOC in 1st 3 months of life
Cefadroxil: 5mg/kg/day: Alternative drug

Follow up for renal scarring
Every six months
Physical growth
Blood pressure
Proteinuria
Every year
Blood levels of urea and creatinine
Ultrsonography
Prompt urine culture for suspeccted UTI
Twice a year through adulthood

Asymptomatic bacteriuria
Bacteriuria on repeated samples on routine check up with no symptoms
0.05 – 1%
No systemic features
No f/s/o inflammation
E coli of low virulence
USG KUB
No treatment

Key messages
UTI in children should not be left unevaluated

UTI should be promptly and effectively treated to avoid acute and long term morbidities

Preventive measures including prophylaxis should be take to prevent recurrence

Long term follow up is mandatory in cases with renal scarring

Music credit:
Aakash Gandhi - lifting dreams

@DIP - Medical Videos | 2020
#UTI #Management #shankar_yadav

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