One of the commonest bacterial infections .
Non specific symptoms May be associated with underlying congenital anomaly .
Risk of UTI 1-3% in boys and 3-10% in girls below 14 years .
During the 1st yr of life, the male : female ratio is 2.8-5.4 : 1. Beyond 1-2 yr, there is a female preponderance, with a male : female ratio of 1 : 10.
Identification and treatment essential to prevent sequeale
Etiopathogenesis
Commonest organism – E. coli
Klebsiella, Proteus, Staph. saprophyticus and Enterococci also implicated
Proteus and Pseudomonas – recurrent UTI, instrumentation, nosocomial
Viral and fungal pathogens also involved
Host defence factors like secretory IgA, proper bladder emptying Bacterial virulence factors
Risk factor
Female gender ,Uncircumcised male ,Vesicoureteral reflux , Toilet training , Voiding dysfunction , Obstructive uropathy , Urethral instrumentation,Genital hygiene , Tight clothing, Pinworm infestation , Constipation , Bacteria with P fimbriae , Anatomic abnormality (labial adhesion) , PUV in male newborns.
specific findings
Poor urine flow , History suggesting previous UTI or confirmed previous UTI , Recurrent fever of uncertain origin , Antenatally diagnosed renal abnormality , Family history of vesicoureteric reflux (VUR) or renal disease .
Enlarged bladder , Abdominal mass , Evidence of spinal lesion, Neurodeficit of lower limbs, patulous anus , Poor growth , High blood pressure .
Sample collection
Midstream clean catch specimen commonly used – suitable for older children Suprapubic aspiration: “Gold standard,” but Variable success rates: 23–90% (higher with ultrasound guidance) Invasive, more painful than catheterization May be no alternative in boys with severe phimosis or girls with tight labial adhesions .
Catheterization Compared to suprapubic aspiration: §Sensitivity = 95% §Specificity = 99%
Bag urine —Can’t avoid contamination —Not ideal for culture . Negative culture rules out UTI, but Positive culture likely to be false-positive —Positive culture requires confirmation, which is not possible once antibiotic is started.
COMPLICATED Vs SIMPLE UTI
COMPLICATED – high fever , systemic toxicity, persistent vomiting, dehydration , renal angle tenderness or raised creatinine .
SIMPLE – low grade fever, dysuria, frequency, urgency and absence of symptoms of complicated UTI .
