URINARY TRACT INFECTION P R O T O C O L
-
Upload
scot-harmon -
Category
Documents
-
view
215 -
download
0
description
Transcript of URINARY TRACT INFECTION P R O T O C O L
![Page 1: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/1.jpg)
URINARY TRACT INFECTION
P R O T O C O L BY
AHMED SOLIMAN ABDELHALIM SOLIMAN ,MDLECTURER OF PEDIATRICS
PEDIATRIC NEPHROLOGY &DIALYSIS UNITBENHA UNIVERISITY
EL HADA ARMED FORCES HOSPITAL ,TAIF, KSA(LAST UPDATE NOVEMBER 2014)
![Page 2: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/2.jpg)
BASICS INTRODUCTION • It Is A Potential Serious Infection• The Highest Incidence In The First
Year Of Life• It May Be Pyelonephritis Or
Cystitis • The Commonest Error In The
Management Of UTI In Children, And Especially In Infants, Is Failure To Establish Is The Diagnosis
![Page 3: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/3.jpg)
• Escherichia coli remains the predominant uropathogen.
• Other organisms such as klebsiella , proteus and enterobacter species , staphylococci, and Streptococcus faecalis , GBS.
• Hematogenous spread is common in
newborns and infants in contrast to ascending infection in older children
BASICS Organisms
![Page 4: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/4.jpg)
E.COLI VIRULENCE FACTORS
![Page 5: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/5.jpg)
BASICS DEFINITIONS (CLASSFICATION)
![Page 6: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/6.jpg)
CLINICAL APPROACH OF
UTI
![Page 7: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/7.jpg)
STEP 1 : HOW TO SUSPECT UTI ?
STEP2: HOW TO DIAGNOSE UTI (CULTURE)?
STEP 3 : IDENTIFY THE SITE OF UTI
STEP 4 : ANTIBIOTIC THERAPY FOR UTI
STEP 5 : WHAT IS THE UNDERLYING PATHOLOGY ?
STEP6: FOLLOW UP FOR RECURRENCE ?
CLINICAL UTI APPROACHO C T O B E R 2 0 1 3
![Page 8: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/8.jpg)
NICE guidelines recommend the testing of urine in infants and children with: • Symptoms and signs of UTI. • Unexplained fever of 38 ° C or higher • An alternative site of infection but who remain unwell .
STEP (1 ) :How to suspect UTI? O C T O B E R 2 0 1 3
![Page 9: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/9.jpg)
The gold standard for diagnosis of UTI is the urine culture.
Tests That Help Improve the Predictive Value of UTI • Presence of >10 white blood (HPF)
(77%,89%)• Nitrate reductase test (50%,98%)• Leukocyte esterase test (84% ,78%) • The combination of leukocyte esterase
and nitrite tests(72%,96%)
STEP 2:Diagnosis
![Page 10: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/10.jpg)
NICE recommended techniques • Catheter sample or suprapubic aspiration (SPA),
• method of choice in the severely ill infant under 1 year,
• requiring urgent diagnosis and treatment, and in cases where
Alternatives (not NICE recommended) An adhesive plastic bag (screening test). midstream sample.
STEP2 : Diagnosis
![Page 11: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/11.jpg)
STEP3 :IDENTIFY SITE
• Abdominal us (not sensitive)• DMSA (most senstive)• CT with contrast (risky)• MRI with contrast
(expensive)
![Page 12: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/12.jpg)
DMSA
![Page 13: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/13.jpg)
CT (contrast)
![Page 14: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/14.jpg)
MRI (contrast)
![Page 15: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/15.jpg)
• Age • Pyleonephritis or cystitis • General conditions • Choice of antibiotics • Doses of antibiotics .
STEP 4:Treatment
![Page 16: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/16.jpg)
Below 3 months of age
Start parentral antibiotics for 2-4 days then oral for
10 days
Above 3 months of age
Pyleonephritis Cystitis
start oral antibiotics for 7
days unless vomiting Start
parentral antibiotics for 2-4 days then oral for
10 days Oral antibiotics for 3
days
NICE guidelines regarding antibiotic treatment 2007 are as follows
![Page 17: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/17.jpg)
Treatment
![Page 18: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/18.jpg)
Step 5 :Identify underlying pathology
Role out obstructive uropathy especially VUR
![Page 19: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/19.jpg)
Recurrent UTI
Two attacks in less than 6 monthsRecurrence is seen in 30–50 % The risk factors for recurrent UTI
• Girls • Age <6 months • Phimosis/labial adhesions • Obstructive uropathy • Voiding dysfunction • Constipation • High-grade vesico-ureteral reflux
(VUR)
![Page 20: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/20.jpg)
Recurrent UTI : VUR
![Page 21: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/21.jpg)
Recurrent UTIChemoprophylaxis “AAP 2013”
Recurrent without VUR
Recurrent with VUR
evidence that prophylactic antibiotics prevent recurrent
UTI in children without VUR is weak.
• Antibiotic prophylaxis may not be warranted in children with low-grade (grade I–II) VUR.
• antibiotic prophylaxis may have a role in grade III–V VUR, especially in children <5 years of age
![Page 22: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/22.jpg)
Recurrent UTIChemoprophylaxis choice
![Page 23: URINARY TRACT INFECTION P R O T O C O L](https://reader036.fdocuments.in/reader036/viewer/2022062600/5a4d1b1f7f8b9ab0599949b1/html5/thumbnails/23.jpg)
BENHA UNIVERISITY BENHA UNIVERISITY HOSPITALS
PEDIATRIC NEPHROLOGY & DIALYSIS UNIT