1. Urinary Tract Infections
بسم الله الرحمن الرحيم
Urinary Tract Infections
Dr Satti Abdulrahim Satti
Pediatric Consultant

2. Etiology In 5% of girls & 1% of boys. In infancy more common in males.
More common in uncircumcised boys.
Incidence in breast fed infants is lower than in those fed with formula.

3. UTIs is a risk for development of renal insufficiency or end-stage renal disease.
Caused by :
# E. Coli (in 90%)
# Klebsiella organism.
# Proteus “ .
# Staph. Saprophyticus.
# Adenovirus (as cystitis)

4. Pathogenesis & Pathology
An ascending infection from fecal flora or flora beneath the prepuce.
Rarely a hematogenous spread.
Renal injury & scarring.

5. !! Vesicoureteral reflux.
Risk factors for UTI :
!! Vesicoureteral reflux.
!! Obstructive uropathy.
!! Instrumentation or Cathet.
!! Uncircumcision .
!! Tight clothing .
!! Neuropathic bladder.
!! Pinworm infection.
!! Voiding dysfunction.
!! Constipation.

6. Clinical M. & Classification
There are 3 basic forms of UTI
(1) Pyelonephritis
# Acute pyelonephritis or Pyelitis.
# Characterized by : Abd. or flank pain, Nausia & Vomiting, Fever, Malaise & Diarrhea (occasionally).
# Acute pyelonephritis may result in scarring.

7. # Nonspecific symptoms in newborns & infants :
> Poor feeding.
> Irritability .
> Jaundice .
> Wt. loss.

8. Cystitis Bladder involvement with: # Dysuria & Urgency.
# Frequency & Incontinence.
# Suprapubic pain .
# Malodorous urine .
# No fever or renal scarring.

9. (3) Asymptomatic bacteriuria
@ A +ve urine culture without any manifestations .
@ Only in girls .
@ Benign with no scarring.

10. Diagnosis Clinically . Urine analysis.
Urine culture (confirm & therapy)
Ways to obtain a urine sample :
& Midstream urine sample.
& Sterile collection bag (infants)
& Catheterized specimen .
Put urine in fridge until it can be cultured.

11. Culture : ≥ 100 000 colonies (+ve) ≤ 10 000 “ ( -ve)
Pyuria & WBC casts.
Positive Nitrites & Leukocyte esterase.
Microscopic hematuria.
↑ WBC, ↑ ESR & +ve CRP.

12. Treatment

13. !! Children with a nontoxic appearance are treated with oral fluids and antibiotics. !! Toxic-appearing children must be treated with intravenous (IV) fluids and parenteral antibiotics.

14. !! Initial treatment may consist of a single dose of ceftriaxone (75 mg/kg IV/IM q12-24h). !! Treatment may be with gentamicin (2.5 mg/kg IV/IM as a single dose). !! Then switch to an oral antibacterial agent.

15. Acute Cystitis @ Nitrofurantoin 5 mg/Kg/d in 3-4 doses .
@ Sulfamethoxazole-trimethoprim Septrin (Bactrim)
@ Nitrofurantoin 5 mg/Kg/d in doses .
@ Amoxicillin mg/Kg/d

16. Pyelonephritis @ Ceftriaxone 50-75 mg/Kg/d Inj.
@ Ampicillin mg/Kg/d “ +
@ Gentamycin mg/Kg/d “
@ Amoxicillin/ Clavulanate PO
@ Oral Cefixime .
@ Ciprofloxacin in older children.

17. @ Do urine C/S after 1 wk from termination of treatment .
@ Follow up urine C/S for 1-2 y.
@ For prophylaxis against reinfection:
> Use septrin or nitrofurantoin.
> ⅓ rd of therapeutic dose OD.

18. Imaging Studies To identify anatomic abnormalities. Hydronephrosis.
Renal Ultrasound : Abscesses .
Hydronephrosis.
Acute pyelonephritis(↑kidney)
Show 30% of renal scars.
40% of reflux cases.

19. Voiding Cystourethrogram (VCUG)
€ Indicated in:All children <5 y with a UTI.
A child with a febrile UTI.
Girls with 2 or more UTIs.
Any male with a UTI.
€ May show Vesicoureteral reflux .
Computed Tomography (CT)
Effective in renal scanning.

20. Renal Scanning with DMSA
> For acute pyelonephritis (photopenia)
> To detect renal scarring.

21. Thank You All