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URINARY TRACT INFECTION

PRESENTER :
NURUL ZAIREEN SYAZWANA BT ZAINAL
INTRODUCTION
UTIs include Cystitis (infection localized to the bladder),
Pyelonephritis (Infection of the parenchyma, calyces and renal pelvis)
and Renal Abscess
About to 3-7% of girls and 1-2% of boys have at least on symptomatic
UTIs before the age of 6 years
Causal Agent

E. coli (most Proteus


Klebsiella sp.
common) Mirabilis

Enterococcus
Pseudomonas
Faecalis
RISK FACTORS
Female
Uncircumcised boy
Congenital anomalies(vesicoureteral
reflux)
Toilet training and hygiene
Age group Symptoms and signs
Most common ------------------> Least common
Infants younger than 3 months Fever Poor feeding Abdominal pain
Vomiting Failure to thrive Jaundice
Lethargy Haematuria
Irritability

Infants and Preverbal Fever Abdominal pain Lethargy


children, Loin tenderness Irritability
3 months and > Vomiting Haematuria
Poor feeding Failure to thrive

Verbal Frequency Dysfunctional Fever


Dysuria voiding Malaise
Changes to Vomiting
continence Haematuria
Abdominal pain
Loin tenderness
Clinical Features
Infant Children
fever Dysuria & frequency
Vomitting Abdominal pain or loin tenderness
Lethargy or irritability Fever with/without rigor
Poor feeding or failure to trive Lethargy and anorexia
Jaundice Vomitting, Diarhhea
Septicemia Hematuria
Offensive urine Offensive/cloudy urine
Fibrile convulsion (More than 6 month) Fibrile Convulsion
Recurrent of enuresis
PHYSICAL EXAMINATION
Distended bladder
Ballotable kidney
Loin tenderness

Older children:
Renal punch positive
Urethral
Suprapubic catheter
aspiration

Collection
of urine Adhesive

sample plastic bag

Midstream
urine sample
( older child)
Investigation
Suprapubic
aspiration

Midstream
Clean catch
sample (older
sample
children)
Collection of
sample

Urethral Adhasive
catheter plastic bag
INVESTIGATIONS
Urine dipstick
Nitrite and/or leukocytes esterase

Urine culture
Method and interpretation of dipstick testing in children
Methods of dipstick testing
Nitrite stick testing Positive result useful as very lightly to indicate a true uti
(some children are nitrite- negative)

Leukocyte esterase stick testing (for WBC) May be present in children febrile illness without uti
Positive in balanitis and vulvovaginitis

Interpretation of results
Leucocyte esterase and nitrite positive Regard as UTI
Leucocyte esterase negative and nitrite Start antibiotic treatment
positive Diagnosis depends on urine culture

Leucocyte esterase positive and nitrite Only start antibiotic treatment if clinical evidence of UTI
negative Diagnosis depends on urine culture
Leucocyte esterase and nitrite negative UTI unlikely. Repeat or send urine for culture if clinical history
suggest UTI
Blood, protein and glucose present on stick Useful in any unwell child to identify other disease ( nephritis,
testing DM), not discriminate between children with or without UTI
X-ray of KUB

VUR
MANAGEMENTS
IV rehydration.
< 3months : IV cefotaxime for acute
>3months :
UPPER UTI:
oral co-amoxiclav (7-10days)/
IV cefotaxime (2-4 days) followed by
oral antibiotic (3-5 days)

LOWER UTI
amoxicillin / first generation of cephalosporin (cefalexin) (3 days)
ANTIBIOTIC PROPHYLAXIS
Indicated for : -recurrent UTI
->2 years with anomalies
-severe reflux
Trimethoprim, nitrofurantoin, cephalexin
PREVENTIONS
Good perineal High fluid
hygiene intake

Regular
Circumcision
voiding

Ensuring
complete
emptying

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