Urinary Tract Infections in Children

Prof. Pushpa Raj Sharma

The Differences

• Difficult in collecting samples

• Symptoms are non specific

• Associated with congenital anomalies

• Risk of having serious complications

• Risk factors

• Permanent renal damage

• Poor long term prognosis

The Differences

The risk of recurrence of UTI if infected before one yearOf age is 18% in boys and 48% in girls.

Prevalence of UTISharma PR et al

JIOM (1983);5:19-22

7.3% of all childhood illness admitted in KCH

Ball CS et al Paediatrics (1999):Vol11;143-149

Less than one year

Girls:6.5%; Boys: 3.3%

Kaushal RK et al Indian Pediatrics(2003) Vol 4

Girls: 8.4%; Boys: 6.1%

Kanti Children’s HospitalMonthly data review, 2003

64% of Urinary disease

Hemsagar R : 2 months to 2 years with fever (2003)

Female: 38.7%

Male: 18.7%

Symptoms*

– Fever 80%– Failure to thrive 12-15 %– Fainting 6.1%– Fast breathing 6.3%– Fowl smelling urine 43-20%– Feeding problems 83-17%– Frequency of urine 34-12%– Frequent vomiting 48-43%– Frequent constipation 2%– Frequent diarrhoea 8-18%

*Rimal H and Sharma K (MD Thesis)

The Symptoms

Aetiologial Agents

0

10

20

30

40

50

60

70

80

90

E.coli

S.aureus

Pseudom

Klebsiel

Proteus

S.typhi

Serratia

S.fecalis

H.S. Rimal / K.R. Sharma

Antibiotic Sensitivity of the commonest etiological agent

Antibiotics sensitivity

E.coli

Gentamycin 62.5%

Amikacin 55%

Cotrimoxazole 60%

Nalidixic acid 35%

Ciprofloxacin 47.5%

Rimal HS

Complications of UTI

• Acute Pyelonephritis

• Chronic pyelonephritis

• Renal scarring

• Hypertension

• Sepsis

Investigations for UTI

• Routine urine examination

• Culture

• Ultrasound

• DMSA scanning

• Micturating cystourethrogram

• CT/MRI

Treatment

• Acute attack: oral/IV antibiotics

• Repeated attacks: prophylactic

• Surgical treatment