Urinary tract infection resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rana aljebzi, M.D.[2]

Synonyms and keywords: Urinary tract infection in kids, UTI in kids, UTI in pediatrics, pedicatrics urinary tract infection

Urinary tract infection resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Urinary tract infections (UTIs) are common in kids. it occurs when bacteria (germs) get into the bladder(lower tract infection) or kidneys(upper tract).abdominal pain and loin tenderness, with systemic features fever, anorexia, vomiting, lethargy and malaise is the signs of upper tract infection while lower abdominal or suprapubic pain, dysuria, urinary frequency and urgency is lower tract infections signs.in younger children the typical signs are not clear and it is difficult to differentiation between upper and lower tract infection, Up to 8% of girls and 2% of boys will get a UTI by age 5 Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition,usually With the right treatment, your child should start to feel better in just a few days.

Causes

Life Threatening Causes

Urinary tract infections has two basic types,bladder infection and kidney infection. if the infection is in the bladder it is called cystitis and it causes pain and swelling in bladder, while if the infection traveled up to the kidneys in this condition ,it is called pyelonephritis and it is serious and it might harm the kidneys.

infection

• E.coli ,is the most common cause of UTI in children of all age.
• Klebsiella, is the second common cause.
• Proteus
• Enterobacter and Enterococcus
• Citrobacter
• Staphylococcus saprophyticus
• Candida albicans.

Mechanical

• vesicoureteral reflux , is the most common predisposing factor in recurrent UTI.
• urinary obstruction.

FIRE: Focused Initial Rapid Evaluation

UTI should be considered in any infant or child presenting with fever without an identifiable source of infection.because it can be associated with acute mortality (i.e. urosepsis) and/or chronic medical problems like renal scarring, hypertension, and chronic renal insufficiency,that is why urinalysis and urine culture should be done.The AAP (American Academy od pediatrics) recommendations for imaging after an initial febrile UTI were extensive and included renal and bladder ultrasound, voiding cystourethrography (VCUG) or radionuclide cystography in all children younger than two years of age

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of UTI in children according the the AAP [American Academy of pediatrics] guidelines.

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Child with fever or symptoms of UTI

Stable

Unstable/Sepsis

Child with fever or symptoms of UTI

Treatment

Shown below is an algorithm summarizing the treatment of UTI in children according to the AAP [American Academy of pediatrics] guidelines.

• The goals of treatment are:
  • Elimination of the acute infection
  • Prevent the complication
  • Reduce the renal damage

Table1

Some Empiric Antimicrobial Agents for Oral Treatment of UTI.

Antimicrobial Agent	Dosage
Amoxicillin-clavulanate	20–40 mg/kg per d in 3 doses
Sulfonamide
*Trimethoprim-sulfamethoxazole	6–12 mg/kg trimethoprim and 30-60 mg/kg sulfamethoxazole per d in 2 doses
*Sulfisoxazole	120–150 mg/kg per d in 4 doses
Cephalosporin
*Cefixime	8 mg/kg per d in 1 dose
*Cefpodoxime	10 mg/kg per d in 2 doses
* Cefprozil	30 mg/kg per d in 2 doses
* Cefuroxime axetil	20–30 mg/kg per d in 2 doses
*Cephalexin	50–100 mg/kg per d in 4 doses

Table2

Some Empiric Antimicrobial Agents for Parenteral Treatment of UTI

Antimicrobial Agent	Dosage
Ceftriaxone	75 mg/kg, every 24 h
Cefotaxime	150 mg/kg per d, divided every 6–8 h
Ceftazidime	100–150 mg/kg per d, divided every 8 h
Gentamicin	7.5 mg/kg per d, divided every 8 h
Tobramycin	5 mg/kg per d, divided every 8 h
Piperacillin	300 mg/kg per d, divided every 6–8 h

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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