Urinary Tract Infection

exp date isn't null, but text field is

Introduction

  • UTI is a potential cause of renal scarring, calculi, ht, crf.
  • Can be associated with various anomalies and voiding dysfunction.
  • Urinary tract obstruction is a risk factor
  • Refers to the invasion of urinary tract by pathogenic organisms.
  • UTI include cystitis, pyelonephritis and asymptomatic bacteriuria
  • Breast feeding has been associated with reduced  risk of UTI in child < 6months

Incidence varies according to the age and sex: 1-3% of girls. At <1 year, males > female with a ratio of 2.8-5.4:1 and at 1—2 years females > males at a ratio of 10:1

Neonates: 1-4%; M>F (preterms 2.9%,full term  0.7%)

Infants( 1 month-1 year): 1.1-1.2&(2%) M=F >7yrs: 2.5% F>M

Clinical features:

  • Neonates: Non-specific - Vomiting, irritability, diarrhea, poor feeding, failure to thrive, dehydration
  • Infants and toddlers: fever may or may not be present
  • Older children: Frequency, urgency, dysuria, abdominal pain, enuresis, flank pain, hematuria

Investigations

Urinalysis:

  • Best specimen for this and MCS is the supra-pubic aspirate.
  • Mid Stream Urine can also be used
  • Clean voided bag specimen in 2months – 2yrs
  • WBC > 5HPF
  • pH- proteus produces alkaline pH
  • microscopic hematuria

Urine MCS:

  • any colony count following a Supra Pubic Aspirate is diagnostic
  • 100,000 cfil/ml – female
  • 10,000   cfil/ml -  male

Others :

  • Renal ultrasound
  • DMSA( dimecaptosuccinic acid)- parenchymal filling defect in acute pyelonephritis

It is superior to RUSS and IVU

MCUG: may be indicated in suspected anatomic anomaly e.g. reflux, PUV.

IVU:     

  • produces information regarding precise anatomic image
  • estimate renal function not reliable for detecting renal scarring or pyelonephritis
  • large dose radiation  is required

Renal cortical scintigraphy

Complications

Immediate     

  • bacteremia
  • dehydration

Late

  • chronic urinary tract infection
  • Renal scarring
  • Hypertension

Treatment

Goal: To eradicate the causative organism and correct associated symptoms 

Specific – antibiotics for  10-14 days

  • Cotrimoxazole
  • Ceftriaxone
  • Cefixime
  • Amoxyl/clavulanic

Supportive

  • hydration
  • feeding
  • perineal education