O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Pediatric urinary tract infection

2.081 visualizações

Publicada em

pediatric urinary tract infection

Publicada em: Saúde e medicina
  • 1 cup burns 1lb of diabetic fat every 72 hours... ◆◆◆ http://t.cn/AiBhrKDq
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • Have You Seen Linda Allen's new Candida System yet? It's called "Yeast Infection No More" I've read the whole thing (all 150 pages) and there's some great information in there about how to naturally and permanently eliminate your yeast infection without drugs, creams or any kind of gimmicks. I highly recommend it - it's very honest and straightforward without all the hype and b.s. you see all over the net these days. Here's the website where you can get more information:  http://ishbv.com/index7/pdf
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • I have suffered from a widening array of allergies and constant cravings for sugar and bread. I was miserable most of the time while taking allergy medication. After following your step-by-step directions for 6 weeks, I am recovering! I am now, as I write this lines, almost symptom free. I recommend anyone who is affected by allergy caused directly or indirectly by candida yeast infection to read your book. It is so easy to read (even for me - English is not my native language) and to apply. I cannot thank you enough for your counseling service and for the knowledge and health you have brought into my life. ➤➤ http://ishbv.com/index7/pdf
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui

Pediatric urinary tract infection

  1. 1. Pediatric Urinary tract infection Dr. Srinivasaraghavan. R AP, Department of Pediatrics
  2. 2. Objectives • Forms of UTI in children • Diagnosis of UTI • Treatment of UTI • Complications • Recurrent UTI- risk factors
  3. 3. Why know about pediatric UTI? • One of the commonest infections in children • Young infants- sepsis- mortality if not recognized • Renal scarring- hypertension and progressive renal damage
  4. 4. Epidemiology • 1% of all boys and 1-3% of all girls- UTI • 1st yr- M:F- 2.8-5.4 : 1 • Beyond 1-2 yr- M:F -1 : 10
  6. 6. Etiologic organisms • Uropathogens- mostly bacteria from stools- ascending infection from peri-urethral area or via bacteremia • Bacteria- E.coli (most common- 75-90%), Klebsiella, Proteus, Pseudomonas aeruginosa, Staphylococcus saprophyticus, GBS • Candida • Adenovirus- hemorrhagic cystitis
  7. 7. Symptoms Upper UTI • High grade fever, toxic look • Vomiting, nausea • Abdominal pain- flanks • Diarrhea Cystitis • Dysuria • Urgency • Frequency • Supra-pubic pain • Hematuria • Usually no fever
  8. 8. Simple vs complicated UTI • Complicated – Presence of fever >39 ⁰C – systemic toxicity – persistent vomiting – dehydration – renal angle tenderness – raised creatinine • Simple – low grade fever – Dysuria, frequency, and urgency – absence of symptoms of complicated UTI
  9. 9. Symptoms contd.. • 0-2 months- sepsis- poor feeding, lethargy- rarely cholestasis and failure to thrive • 2months- 2 years- fever without focus • Older children- may present as secondary enuresis
  10. 10. Evaluation • Fever? Other symptoms? • Feeding well? Vomiting? • Toxic? Dehydrated? • Shock features? Sepsis? • Spine examination and genitalia- Bladder- bowel dysfunction
  11. 11. Phimosis
  12. 12. Phimosis
  13. 13. Diagnosis • Counts- WBC counts high in upper UTI, serum creatinine • Screening – Urine microscopy- leukocytes – Rapid dipstick tests- leukocyte esterase and nitrite • Obtaining sample: – Midstream clean catch- cleaning with soap and water – Urine bag samples- not good – Neonates and infants- suprapubic aspiration/ transurethral bladder catheterization • Plate within 1 hour- if delay anticipated- refrigerator at 4⁰C for up to 12-24 hours
  14. 14. Diagnosis • Urine culture- gold standard
  15. 15. Treatment • < 3 months of age and those with complicated UTI- hospitalized, parenteral antibiotics • Ceftriaxone/ Cefotaxime/ Amikacin/ Gentamicin • Others- oral therapy- Cefixime/ Cephalexin/ Amoxy-clav/ Ciprofloxacin • Symptoms mild/ diagnosis doubtful- delayed until the results of culture
  16. 16. Duration • Infants and children with complicated UTI- 10- 14 days • Uncomplicated UTI- 7-10 days • Adolescents with cystitis- 3 days • Supportive measures- hydration
  17. 17. Culture proven UTI- Follow up Investigation < 1 yr 1- 5 yr > 5 yr USG + + + DMSA + + Only if USG abnormalMCU + Only if any of the above is abnormal
  18. 18. DMSA • Right lower pole and left kidney scarring + • Normal study
  19. 19. Recuurent UTI- risk factors • Bowel and bladder dysfunction • Structural abnormalities of the urinary tract- VUR, PUV, duplex ureter • Constipation • Catheterization • Worm infestation • Alteration of peri-urethral flora by antibiotic therapy
  20. 20. Prevention • Adequate fluid intake • Frequent voiding • Constipation- avoided • Circumcision- high grade reflux in children
  21. 21. VUR • 40-50% infants and 30-50% children with UTI • Primary vs secondary • Secondary VUR- bladder outflow obstruction, as with posterior urethral valves, neurogenic bladder or a functional voiding disorder
  22. 22. VUR Grades • Classification- based on MCU appearance- grade I to V- I to III- Low grade, IV and V- high grade • Bilateral grade IV and grade V- risk factor for pyelonephritis and scarring
  23. 23. MCU
  24. 24. Treatment • Prevention of recurrent UTI- Antibiotic prophylaxis till 5 years of age • Low grade VUR- subsides spontaneously • High grades- need surgical repair
  25. 25. Take home messages • Causes of UTI in children • Upper UTI vs Lower UTI • Diagnosis • Treatment guidelines