Urinary Tract Infection in the paediatric patient

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Urinary Tract Infection in the paediatric patient
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Dr. Padmasani Venkat Ramanan, MD*

Introduction:

The urinary tract is a common site of infection in infancy and childhood. It is of special significance for the following reasons.


a. Symptoms are non specific in infants and small children. Unpleasant symptoms like enuresis, fever and vomiting interfere with infant feeding and schooling.
b. There is a risk of renal damage (especially if vesicoureteral reflux or outflow obstruction is present) leading to chronic pyelonephritis, hypertension and end stage renal disease in later life.
c. It has a tendency to recur even in the absence of identifiable predisposing factors.
d. It could be the first indicator of an underlying obstructive uropathy.

Aetiology

Host factors: Urinary stasis due to outflow obstruction either mechanical or functional, stones, vesicoureteral reflux and incomplete voiding all increase the risk of acquiring UTI.


Urinary pathogens: are derived from the normal faecal flora. E.Coli causes > 90% of the first infections. The other common organisms are Klebsiella, Proteus, Enterococcus and Pseudomonas.

Clinical presentation
1. With classical symptoms dysuria, frequency, abdominal pain, haematuria, enuresis, cloudy or offensive urine.
2. With symptoms not directly related to the urinary tract such as fever, alimentary disturbances, impaired growth, feeding problems or anorexia.
3. Asymptomatic bacteriuria may be found during a screening programme or on follow up of a prior UTI.
The clinical picture is influenced by age. In the neonatal period the infant may present with excessive weight loss, prolonged jaundice, diarrhoea, vomiting and lethargy.

Evaluation of a sick infant is incomplete without examination of the urine.

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drmaverick 

Plz also add antibiotics of choice along with dosages.

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