URINARY TRACT INFECTIONS

Dr I Ketut Suarta Sp.A(K)

Dr. GAP Nilawati Sp.A

Nephrology subdivision, Child Health

Department of Udayana University/Sanglah
General Hospital
Prevalence and Etiology

The most infection in children after ARTI

(Acute Respiratory Tract Infection)
Incidence < 14 yr : 1 % boy
3 – 5 % girl
< 1 yr : boy > girl
(more common in uncircumcised boys)
Upper UTI > Lower UTI
Incidence of UTI : 1 – 2 % female
students
Urinary tract congenital anomaly→
predisposes UTI
Unexplained fever → UTI suspected
 Clinical manifestation
Neonate:
o Failure to thrive
o Anorexia
o Diarrhea
o Vomiting
o Fever
o Jaundice (Hyperbilirubinemia)
1 month - 2 year
o Anorexia
o Failure to thrive
o Diarrhea
o Fever
o Abdominal colic
o Irritable
2 - 6 year
– Gastrointestinal symptoms
– Urgency
– Dysuria
– Frequency
– Abdominal pain
6 -8 year: most common symptoms
Urgency
Dysuria
Frequency
Abdominal & waist pain
Included:
 Diagnosed
 Bacterial eradication
 Antibiotic prophylaxis
 Imaging
 Therapy
 Follow up
Diagnosis

Diagnosis → Urine culture

Several ways to obtain urine sample:
Suprapubic aspires → bacteria (+) → UTI
Midstream urine sample → colony count
105 → UTI
 …………tatalaksana

Anatomic location

Needle position
 Leukocytes urine → UTI suspected if the
child is symptomatic
 UTI can occur with hematuria → woman
 Urine examination should be fresh sample
urine
1 – 2 hour urine → false positive
UTI based on location:
Upper UTI:
Frequently with anatomic abnormalities of
urinary tract
High fever
Urine: light cells, leukocyte casts
Antibody coated bacteria
Lactic dehydrogenase
ESR ↑
Leucocytosis
USG → enlarged kidney
 Lower UTI
Predisposition factor:
 Short Urethra in female
 Uncircumcised
 Hydronephrosis
 Reflux vesicoureter
 Completeness of voiding
 Congenital malformation
 Nephrolitiasis
 Other factors which caused stasis urine
Etiologi
Escherechia coli ( >>)
Klebsiella
Proteus
Staphylococcus
If there was obstruction or anomaly
Therapy
* UTI should treated soon
* Neonate → parenteral (IV/IM) antibiotic for 10 –
14 days
* Child (cystitis) → oral antibiotic ± 7 days
(amoxicillin & clavulanic acid)
* Pyelonephritis (Upper UTI) → antibiotic
• Cephalosporin
• Gentamycine
→ fever decrease →oral antibiotic for 14 days
* Repeated urine culture: 4 days after antibiotic
was stop
* Repeated urine culture every month for 3 month,
continued every 3 month for 1 year
Thank You