ppt uti in children

7/27/2019 ppt uti in children

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Diagnosis and Treatment of UTI

in children

Novina Firlia F Putri


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Overview

1. Definitions and diagnosis

2. Acute management

3. Prevention

(Practical Points)

4. Diagnosis and Treatment


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Definitions

Symptomatic bacteriuria

bacteriuria + symptoms

Afebrile UTI (i.e. T 38C in cystitis)

Febrile UTI (i.e. acute pyelonephritis in 80%)

Asymptomatic bacteriuria

also known as covert or latent

bacteriuria in well children

1-2% prevalence

treatment confers no benefit, only harm


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Clinical Practice Guidelines

AAP (2011) NICE (2007) PPS (2004)

Action Statement 2:

If a clinician assesses a

febrile infant with no

apparent source for the

fever as not being ill as torequire immediate

antimicrobial therapy, then

the clinician should assess

the likelihood of UTI.

Infants and children

presenting with

unexplained fever of 38C

or higher should have a

urine sample tested after24 hours at the latest.

Febrile infants (>38C)

below 2 years of age


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MOST COMMON INFECTING PATHOGEN : ESCHERICHIA COLI 80% OF UTI.

Route of

infection:

Neonate: Hematogenous

Child : Ascendingbacteria


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PATHOGENETIC ASPECTS IN UTIs


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URINARY TRACT INFECTION

SIGNS AND SYMPTOMS

Frequent and painful voiding of small amounts of cloudy

urine

Foul-smelling urine

Fever and shivering

Abdominal and lumbar pain

Nausea and vomiting

Finnell SM et al Technical reportDiagnosis and management of an initial UTI

in febrile infants and young children. Pediatrics. 2011 Sep;128(3):e749-70.


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Practical Point

If the aim is to detect all

children with UTI then a

culture is always required

In a low prevalence setting

(eg. children with fever and

no other symptoms)

Urine microscopy for

bacteria is the best test


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Clinical Practice GuidelinesAAP (2011) NICE (2007) PPS (2004)

Action Statement 2b:

Urinalysis results suggest a

UTI is (+) LE or nitrite or

microscopic analysis (+)

leucocytes or bacteria.

< 3 years old: Use urgent

microscopy and culture to

diagnose UTI.

3 years old: Use dipstick

test to diagnose UTI.

Bacteriuria more specific.

GS on an uncentrifuged

urine specimen has the

best sensitivity and false

positive rate.

AAP (2011) NICE (2007) PPS (2004)

Action Statement 3:

To establish diagnosis of

UTI, clinicians should

require BOTH urinalysisresults (pyuria and/or

bacteriuria) AND the

presence of at least 50,000

CFUs per ml of a

uropathogen.

No statement SPA: any number

Catheter: symptoms +

50,000 CFUs/ml

Clean-catch: symptoms +105 CFUs/ml

Clean-catch:asymptomatic

+ 105 CFUs/ml in at least 2

specimens on different

days


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Diagnostic Criteria

Symptoms of UTIplus significant counts of

bacteria in the urine

Definite UTI bladder tap: any growth

catheter: 104/mL

voided: 105/mL

single organism


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Practical Point

First ask how the urine sample was collected and

handled before acting on it.

At least 4 hours in the bladder before sampling

Processed within 30 minutes (fresh) or within 6 hours in4C

Only treat symptomatic children

104/mL in a voided sample in a symptomatic child =

UTI


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AAP (2011) NICE (2007) PPS (2004)

Action Statement 4b:

The clinician should choose

7 to 14 days as the

duration of antimicrobial

therapy.

3 months to 3 years old

with febrile UTI: 7-10 days

3 months to 3 years old

with afebrile UTI: 3 days

No statement


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ANTIBIOTIC DOSING

COMMON

ADVERSE

EFFECTS

Amoxicillin/clavulanate (Augmentin)

25 to 45 mg per kgper day, divided

every 12 hours

Diarrhea,nausea/vomiting,

rash

Cefixime (Suprax) 8 mg per kg every24 hours or dividedevery 12 hours

Abdominal pain,diarrhea,flatulence, rash

Cefpodoxime 10 mg per kg per

day, divided every12 hours

Abdominal pain,

diarrhea, nausea,rash

Cefprozil (Cefzil) 30 mg per kg perday, divided every12 hours

Abdominal pain,diarrhea, elevatedresults on liverfunction tests,nausea

Cephalexin (Keflex) 25 to 50 mg per kg

per day, dividedevery 6 to 12 hours

Diarrhea,

headache,nausea/vomiting,rash

Trimethoprim/sulfamethoxazole(Bactrim, Septra)

8 to 10 mg per kgper day, dividedevery 12 hours

Diarrhea,nausea/vomiting,photosensitivity,rash


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Practical Point

Know half-lives of common antimicrobials.

Febrile UTI, 7-10 days

First-line, oral antibiotics

Intravenous antibiotic


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AAP (2011) NICE (2007) PPS (2004)

Action Statement 5:

Febrile infants with UTIs

should undergo renal and

bladder ultrasonography.

In all children with severe

or atypical illness who do

not respond to treatment

within 48 hours, early

ultrasound scan is

recommended to identify

structural abnormalities of

the urinary tract.

In children over 6 months

of age with simple firsttime UTI that responds to

treatment, routine

ultrasound is not

recommended.

Ultrasonography alone as a

work-up for patients with

proven UTI is inadequate.


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Imaging studies

Imaging typically is delayed 3-6 weeksafter the infection as part of outpatientfollow-up, except in cases in which

urinary tract obstruction is suspected.


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Renal ultrasound

This study adequately depicts kidney size andshape, but it poorly depicts ureters andprovides no information on function.

A voiding cystourethrogram (VCUG)

adequately depicts urethral and bladder

anatomy and detects vesicoureteral reflux(VUR).


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Thank You

ppt uti in children

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