Urinary Tract Infection

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Description

UTIs are usually caused when bacteria invade and ascend the urinary tract from the urethra and into the bladder. Cystitis occurs when the infection and inflammatory response are localised to the bladder. Pyelonephritis is an upper UTI in which the bacteria and subsequent inflammatory response further ascend to the ureters and kidneys. Infants generally present late in the course of infection because of initial nonspecific signs, such as fever, and the inability to express symptoms or localize pain.

Older children can usually localise early symptoms of UTI and therefore present earlier in the clinical course.

Colonic bacteria are the typical causes, these include;

  • Escherichia coli (54% to 67% of UTIs in children).
  • Klebsiella (6%-7%),
  • Proteus (5%-12%),
  • Enterococcus (3%-(%)
  • Pseudomonas (2%-6%) are other common causative organisms.

Signs and Symptoms

  • Fever
  • Dysuria
  • Urinary frequency
  • Suprapubic discomfort
  • Flank pain.
  • Costovertebral pain
  • Abdominal pain

Investigations

  • Urinalysis: A positive nitrite test makes UTI very likely, but the test maybe falsely negative. The leukocyte esterase test is an indirect measure of pyuria.
  • Urine microscopy: A microscopic urinalysis finding of 10 white blood cell per microliter in uncentrifuged urine specimen is significant.
  • Urine culture: For children who are not toilet trained, only urethral catheterisation and SPA are reliable methods for specimen collection for the purpose of culture. For toilet trained children, a midstream urine sample should be collected.

Treatment

  • Start empiric treatment with Quinolones but depends on local susceptible patterns then change according to culture results.
  • Oral antibiotics 10 to 14 days or
  • IV antibiotics for 3 days, then 10 days oral antibiotics