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![Medication
•Cefixime
•Coamoxiclav
•Ciprofloxacin
•Ofloxacin
•Cephalexin
Dose[mg/kg/day]
8 10,
‐
30 35
‐
10 20,
‐
15‐20,
50 70,
‐
BID
BID
BID
BID
ORAL
ANTIMICROBIAL
S ‐ UTI](https://image.slidesharecdn.com/urinarytractinfectionsinchildren-preventionmanagement-250804100006-9ac3508f/75/URINARY-TRACT-INFECTIONS-in-CHILDREN-Prevention-Management-pptx-24-2048.jpg)
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URINARY TRACT INFECTIONS in CHILDREN -Prevention & Management.pptx
- 1. URINARY TRACT INFECTIONSin CHILDREN -Prevention & Management
- 2.
- 3. INTRODUCTION •Most common seriousbacterial infection in young children •5% of febrile infants •Prevalence •In 1st year: M : F :: 2.8 5.4:1 ‐ •>1 year, striking female predominance, M:F :: 1:10 •Higher in uncircumcised boys
- 4. DEFINITI ON UTI • Tissueresponse to the presence of significant proliferating bacteria in the urine • Includes infection of any component of the urinary tract including •Pyelonephritis •Cystitis •Urethritis • Asymptomatic bacteriuria: a positive urine culture without any urinary symptoms, common in adolescent girls
- 5. DEFINITIONS • Simple UTI:UTI with low grade fever, dysuria, frequency, and urgency; and absence of symptoms of complicated UTI • Complicated UTI: Presence of fever >39ºC, systemic toxicity, persistent vomiting, dehydration, renal angle tenderness and raised creatinine. • Recurrent infection: Second episode of UTI.
- 6. DEFINITIONS • Significant bacteriuria:Colony count of 100,000 /mL of a single species in a midstream clean catch sample. • Asymptomatic bacteriuria: Significant bacteriuria in the absence of symptoms of urinary tract infection (UTI).
- 7. ETIOL OGY •Majority caused bybacteria : most important Enterobacteriaciae: family of gram negative ‐ bacilli. •>80% acute UTIs caused by: Escherichia coli •Other causes •Proteus mirabilis • Klebsiella pneumoniae •Pseudomonsa aeruginosa •Less common: Gram positive ‐ cocci •Enterococcus and Staphylococcus saprophyticus
- 8. OTHER CAUSATIVE ORGANISMS Fungal infections,particularly Candida, usually in : 1. Nosocomial Infections 2. Complicated UTI 3. Catheter associated ‐ UTI Viral infections under recognized ‐ ‐ because of difficulties with culture and identification, but have been associated with cystitis,esp. adenovirus Cytomegalovirus frequently seen in immunocompromised patients, particularly following organ transplantation
- 9. PATHOG ENESIS Ascending infection : •Bacteriafrom fecal flora colonize via urethra. perineum and enter bladder •In uncircumcised boys : pathogens arise from flora beneath the prepuce •Rarely, bacteria causing cystitis ascend to the kidney to cause pyelonephritis Hematogenous infection‐ unusual •Neonates (GBS, E. coli, Listeria) •GI disease with peritonitis, sepsis •Severely ill children with multi organ ‐ disease •Presence of urinary catheter
- 10. HOST FACTORS THAT PREDISPOSETO UTI Age •Uncircumcised boys •Female infants •Race/ethnicity Urinary obstruction •Neurogenic Bladder • Dysfunctional elimination •Vesicoureteral reflux Sexual abuse Bladder catheterization Unsubstantiated risks •Bathing •Back to front ‐ ‐ wiping
- 11. CLINICAL FEATURES Neonates‐ Poorfeeding,Jaundice,Vomiting,Lethargy, Irritability, failure to gain weight and Fever +/‐‐ Infants Fever ‐ , painful micturation ,Diarrhoea, foul smelling diapers, vomiting etc Child Fever ‐ without focus Nausea, vomiting, abdominal pain ,dysuria ,day time urgency‐ frequency hesitancy incontinence secondary enuresis cloudy urine and Rarely flank ‐ pain
- 12. OTHER IMPORTANT PAST HISTORY •Chronic urinarysymptoms • Incontinence, lack of proper stream, frequency, urgency, withholding maneuvers •Previous undiagnosed febrile illnesses •Chronic constipation •Previous UTI •Vesicoureteral reflux (VUR) •Antenatally diagnosed renal abnormality •Elevated blood pressure •Poor growth
- 13. FAMILY HISTORY •Frequent UTI •VUR • Genitourinaryabnormalities •Renal failure.
- 14. EXAMINATION‐ PHYSICAL EXAMINATION •Documentation of bloodpressure and temperature. •Growth parameters •Abdominal masses bladder, ‐ constipation, renal •Perineum & genitalia •Girls labial ‐ adhesions, vulvovaginitis •Boys presence ‐ & condition of foreskin, stricture at meatus •If incontinent spine, perineal sensation, ‐ anal tone, power & sensation in lower limbs •Sexual abuse
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- 17. HOW TO COLLECT URINE ??? Midstreamclean catch Bag Collection Catheterization Suprapubic aspiration
- 18. • Child Cleancatch ‐ ‐ midstream specimen • Neonates and infants: urine sample is by suprapubic aspiration or transurethral bladder catheterization. • Urine specimen should be promptly plated within one hour of collection. • If delay sample can be stored in a refrigerator at 4ºc for up to 12 24 ‐ hours. COLLECTION OF SPECIMEN FOR CULTURE
- 19. • Leucocyturia –WBC (Pus cells) Uncentrifuged > 10 /mm3 Centrifuged > 5 / hpf (can occur in Fever, GN, Stones, FB in urinary tract) • Urinary enzymes : Leucocyte esterase, Nitrite (combined: Moderate sensitivity and specificity) SUSPECT ED UTI
- 20. Method Colony countProbability Suprapubic Any number 99% Catheter > 50 x 103 95% Midstream > 105 CFU/ml 90 95% ‐ Bag specimen Unacceptable (lower counts significant if symptoms persistent , antibiotics, diuretics ) Note: Prompt plating of the urine sample Or refrigeration until plated URINE CULTURE - SIGNIFICA NCE
- 21. •Contamination is suspected,e.g., mixed growth of two or more pathogens, •Growth of organisms that normally constitute the periurethral flora (lactobacilli in healthy girls; enterococci in infants). •UTI is strongly suspected but colony counts are equivocal. REPEAT URINE CULTURE
- 22. MANAG EMENT • Relief ofacute symptoms • Treatment of infection • Identification of any underlying abnormalities • prevention of recurrence •prevention of long term ‐ complications
- 23. MANAGEMENT • Initiate immediatelyafter culture drawn :Reduces severity of renal scarring • Empirical initially change as per culture ‐ & sensitivity reports • Older children, otherwise well, cystitis: oral therapy x 7 days
- 24. Medication •Cefixime •Coamoxiclav •Ciprofloxacin •Ofloxacin •Cephalexin Dose[mg/kg/day] 8 10, ‐ 30 35 ‐ 1020, ‐ 15‐20, 50 70, ‐ BID BID BID BID ORAL ANTIMICROBIAL S ‐ UTI
- 25. • Infants andchildren in complicated UTI:10‐ 14 days. • Simple UTI: 7 10 ‐ days. • Adolescents with cystitis: 3 days • Following treatment prophylactic antibiotic therapy is initiated in children below 1 year of age. DURATION OF TREATMENT
- 26. MANAG EMENT Intravenous therapy indicated‐ •Dehydrated, Vomiting •Unable To Drink Fluids •<1 Mo Of Age •Suspected Urosepsis Duration 10 14 ‐ days Initially: Inj Ceftriaxone (50 75 ‐ mg/kg/24 hr, not to exceed 2 g) OR Inj Ampicillin (100 mg/kg/24 hr) + an aminoglycoside e.g. Inj. Gentamicin (3‐ 5 mg/kg/24 hr)