Urinary tract infection

Types depend on location Types depend on duration

Upper UTI: Pyelonephritis Acute UTI

Lower UTI: Cystitis Chronic UTI

Micro-organism:
 E. Coli
 Klebsilla
 Proteus
 Strept
 Staph
Risk factors:
 Females*
 Iatrogenic *
 Uncircumcised boy*
 Associated anomalies *
Clinical picture:
Newborn:
 Sepsis
 Jaundice
 Failure to thrive

Infant:
 Fever
 Failure to thrive
 Crying during micturition

Child:
Upper UTI:
 Urgency, frequency, dysuria, hematuria& lower abdominal pain
Lower UTI:
 Fever, rigor, loin pain, hypertension & hematuria
Investigations: +ve Results if:
Urine exam:  > 5 WBCs / HPF
 Urine bag X  > 10 WBCs / ml
 Midstream urine
 Waiting sterile pot
Urine C/S:
 Foly’s catheter
 Suprapubic aspiration SPA
Others:
 CBC *
 ESR *
 Blood C/S*
 DMSA scan *
 Abdominal U/S *
 Micturition cysto-urethro-gram *
Guidelines for imaging in UTI:
Abdominal U/S:
Done during acute infection for:
Infants < 6 months old
Atypical UTI
Recurrent UTI
MCUG:
Done 2-4weeks after UTI resolved for:
2nd UTI
Non E.coli UTI
Poor urine flow
1st UTI + hydronephrosis, scarring, VUR& obstructive uropathy
DMSA scan:
Done 4-6 months for:
Atypical UTI
Recurrent UTI
Child < 3 years old with pyelonephritis
Management:
Supportive& specific& hospitalization:
 Antipyretic for fever
 Tell to drink a plenty of water
 Treat associated bladder& bowel emptying disorder
 Teach the patient how to clean herself after micturition
 Hospitalization for < 1 month, vomiting& pyelonephritis
 Age Antibiotic

< 3 months IV AB for 3 days then switch to oral AB for 7-10 days
> 3 months+ upper UTI Oral AB unless the patient has vomiting you give
IV AB for total 7-10 days
> 3 months+ lower UTI Oral AB for 3? Days
Empirical antibiotics:
Oral antibiotic Parenteral antibiotic
Cotrimoxazole Ceftriaxone
Amoxicillin Cefotaxime
Cefixime Ampicillin+Gentamicin
Ciprofloxacin
Follow up:
 Continue AB till afebrile, resolve S&S, no pyuria
 Change AB according to C/S if no response*
 Urine C/S after 1 week to ensure recovery
 Urine C/S after 3 months for recurrence
Prevention for high-risk group:
 Renal stones
 Voiding dysfunction
 Neurogenic bladder
 Vesico-uretral reflux
Give low dose septrin or nitrofurantoin, hydration& probiotics