urinary tract infections diagnosis, test, types of urinary tract infection, causes, treatment. management, bacteria, E.coli medications,

1. Urinary tract infection i
n children
Definitions, Diagnosis, Causes, Treatment, Management, Conclusions
Erasmus +
http://www.ce170299@gmail.com

2. Background
Urinary tract infection (UTI) is a frequent disorder of
Childhood. Up to 7 percent of girls and 2 percent of b
oys will have a symptomatic, culture-confirmed urinar
y tract infection by six years of age. Urinary tract infec
tion may be suspected because of urinary symptoms
in older children or because of fever, nonspecific sym
ptoms, or failure to thrive in infants.
Urine dipstick analysis is useful for ruling out urinary t
ract infections in cases with low clinical suspicion. Ho
wever, urine culture is necessary for diagnosis of urin
ary tract infections in children if there is high clinical s
uspicion, cloudy urine, or if urine dipstick testing show
s positive leukocyte esterase or nitrite activity. Despit
e current recommendations, routine
imaging studies (e.g., renal ultrasonography, voiding
cystourethrography, renal scans) do not appear to im
prove clinical outcomes in uncomplicated urinary tract
infections.

3. Introduction
UTI is the most common bacterial infection in children aged <2 years ,
and it may be the first symptom of congenital anomaly of the kidneys and
urinary tract (CAKUT), with VUR being the most prevalent. The
assumption thatrecurrent UTIs in patients with VUR lead to renal scarring
and consecutive chronic kidney disease (CKD) had
been the indication for accurate diagnosis and specific treatment of VUR.

4. Welcome
UTI!!
Epidemiology
Up to 7 percent of girls and 2 percent of boys
will have a symptomatic, culture-confirmed
UTI by six years of age.The prevalence of
UTI in febrile infants is greater with younger
age, with a rate of nearly 7 percent among
febrile newborns.
Most UTIs in children result from ascending
infections, although hematogenous
spread may be more common in the first
12 weeks of life. Most UTIs in children are
monomicrobic, often caused by Escherichia
coli (60 to 80 percent of cases), Proteus
(more common in boys and in children with
renal stones), Klebsiella, Enterococcus, and
coagulase-negative staphylococci.
Evidence on risk factors for UTI in children
is limited. UTIs were associated with
constipation, encopresis, bladder instability,
and infrequent voiding in two studies but
not in a cohort of febrile children younger
than two years. Bathing and back-to-front
wiping have not been demonstrated to be
risk factors.
Evaluation
Older children with UTI may have
dysuria,frequency, urgency, hesitancy,
small-volume voids, or lower abdominal
pain. Infants with UTI more commonly
present with nonspecific symptoms such
as fever, irritability, jaundice, vomiting, or
failure to thrive.
Unusual odor of the urine is not helpful in
predicting UTI.
Other conditions may mimic UTI sympto
ms. Acute urethritis or vulvovaginitis may
be caused by various types of irritants,
including chemical (e.g., bubble baths,
soaps), physical (e.g., self-exploration), an
d
biologic (e.g., pinworms). Self-infusion of
water into the urethra was reported in 10
of 31 boys five to 15 years of age
Presenting with a first UTI.

5. Diagnosis
All guidelines agree that UTI in children may be difficult to
diagnose, especially in children aged <2e3 years, because
symptoms and signs in this age group are non-specific. For
this reason, urine tests are warranted not only in children
with typical UTI symptoms, but also in cases of unexplained
fever. The difficulty is obtaining a urine sample from a child
who does not control voiding. There are four techniques for
collecting a urine sample in those children. Non-invasive
techniques include a bag applied to the perineum and
clean catch midstream void, whereas invasive methods
include bladder catheterization and suprapubic aspiration
(SPA).

6. Tests
Growing urinary
tract bacteria in
a lab.
Your doctor may ask for a urine sa
mple for lab analysis to look for w
hite blood cells, red blood cells or
bacteria. To avoid potential conta
mination of the sample, you may b
e instructed to first wipe your genit
al area with an antiseptic pad and
to collect the urine midstream.
Analyzing a urine
sample.
Lab analysis of the urine is
some times followed by a
urine culture. This test tells
Your doctor what bacteria are
causing your infection and
which medications will be
most effective.

7. Types of urinary tract infection
Each type of UTI may result in more-specific signs and symptoms, depending on which part of your
urinary tract is infected.
Upper back and side (flank) pain
High fever
Shaking and chills
Nausea
Vomiting
Kidneys (acute pyelonephritis)
Pelvic pressure
Lower abdomen discomfort
Frequent, painful urination
Blood in urine
Bladder (cystitis)
Burning with urination
Discharge
Urethra (urethritis)
General Symptoms
A strong, persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Urine that appears cloudy
Urine that appears red, bright pink or cola-colored — a sign of bl
ood in the urine
Strong-smelling urine

8. Causes
Urinary tract infections typically occur when bacteria enter the urinary tract through the
urethra and begin to multiply in the bladder. Although the urinary system is designed to
keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria
may take hold and grow into a full-blown infection in the urinary tract.
Infection of the bladder (cystitis). This type o
f UTI is usually caused by Escherichia coli
(E. coli), a type of bacteria commonly found
in the gastrointestinal (GI) tract. However,
sometimes other bacteria are responsible.
Infection of the urethra (urethritis). This
type of UTI can occur when GI bacteria
spread from the anus to the urethra. Also,
because the female urethra is close to the
vagina.

9. Treatment
Antibiotics usually are th
e
first line treatment for
urinary tract infections.
Which drugs are prescrib
ed and for how long dep
end on your health condi
tion
and the type of bacteria
Lifestyle and home remedies
Drink plenty of water.
Water helps to dilute your
urine and flush out bacteria.
Avoid drinks that may
irritate your bladder.
Avoid coffee, alcohol, and
soft drinks containing citrus
juices or caffeine until your
infection has cleared. They
can irritate your bladder and
tend to aggravate your
frequent or urgent need to
urinate.
Use a heating pad. Apply a
warm, but not hot, heating
pad to your abdomen to
minimize bladder pressure or di
scomfort.
Frequent infections
If you have frequent UTIs,
your doctor may make
certain treatment
recommendations, such as
:
Low-dose antibiotics, initiall
y for six months but someti
mes longer
Self-diagnosis and treatme
nt, if you stay in touch with
Simple infection
Drugs commonly recommended for simple
UTIs include:
Trimethoprim/sulfamethoxazole
(Bactrim, Septra, others)
Fosfomycin (Monurol)
Nitrofurantoin (Macrodantin, Macrobid)
Cephalexin (Keflex)
Ceftriaxone

10. Microorganisms ranking for UTI-s
23%
7%
3%
67%
E.Coli
Klebsiella.sp
Pseudomonas.sp
Citrobacter.sp

11. Management
Diagnosis
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Medications
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Medications
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12. Conclusions
The guidelines on UTI in children try to reconcile recent reports on
diagnosis, treatment, and further diagnostics with prior practices an
d
opinions, and costs. As stated above, many studies concerning UT
I in
children are conflicting, and there is still a lack of sufficient data to
formulate coherent, indubitable guidelines, with imaging
diagnostics remaining the main area of controversy. In light
of these analyzed guidelines, it is recommended that urine
tests be performed both in children with typical UTI symptoms and i
n
children with unexplained fever. Urine tests should be performed b
efore administration of antimicrobials.
In toilet-trained children, a clean voided midstream urine sample is
the method of choice for diagnosing a UTI, while catheterization is
a
preferred invasive method of urine sampling in infants and small
children.
Urine sample collected in a bag applied to the perineum can be us
ed as a UTI exclusion method.
Both positive urinalysis and significant bacteriuria are necessary to
diagnose a UTI. Children with positive urine culture and negative
urinalysis, without symptoms, are regarded as having asymptomati
c
It is recommended that the diagnosis of a UTI be dependent on the urine collection
method, and that it is defined by significant bacteriuria as >104 CFU/ml in clean void
ed urine with symptoms, 103 CFU/ml by Catheterization (depending on the laborator
y
standard), and any growth of bacteria by SPA. Since there is no difference in efficacy
between oral and intravenous UTI treatment, parenteral treatment is only required in
children who are severely ill or unabl to retain oral intake. Parenteral antibiotics shoul
d be switched to oral as soon as clinical improvement is observed, usually within 24e
48 h. In
children aged >3 months, the differentiation between upper and lower UTI guides the
treatment.Upper UTI treatment should last 7e10 days, whereas in lower urinary tract
infection this should be 3 days. The choice of antibiotic should be based on local
epidemiology and susceptibility patterns. It is recommend that an abdominal US be
performed on all patients aged <2 years of age and older children with CAKUT risk fa
ctors. VCUG remains a gold standard for the diagnosis and grading of VUR and shou
ld be
performed in children with abnormal abdominal US, recurrent UTI, or other risk factor
s
(recommendation strength 1C). The bottom-up method is recommended in
Evaluating children with UTI: VCUG and, if positive, a DMSA scan. DMSA scans sho
uld be
performed 4e6 months after UTI in children with recurrent UTI, VUR grade IIIeV, and
those who have high risk of renal scarring (i.e. scarring visible on US or clinical sympt
oms:
hypertension, albuminuria). Nevertheless, clinicians treating children with a UTI shoul
d be aware of the existing controversy in order to make good decisions.

13. Thank you
Worked by: Ervis Cara