The Child with probable

Urinary Tract Infection

The Suspect
1. Neonates presenting with clinical
signs and symptoms
2. Febrile infants (>38C) below 2 years
of age
3. Older children manifesting
symptoms referable to urinary tract

The Child with probable

Urinary Tract Infection
Neonates presenting with:
Septic
Temperature instability
Poor feeding
Vomiting
Lethargy or irritability
Jaundice
Fever
Poor weight gain/failure to thrive
Frequency, dribbling, urgency, dysuria

The Child with probable

Urinary Tract Infection
Older infants presenting with:
Vomiting
Fever
Poor weight gain/failure to thrive
Frequency, dribbling, urgency, dysuria
Diarrhea
Abdominal Pain
Weak urinary stream

The Child with probable

Urinary Tract Infection
School age adolescents presenting with:
Jaundice
Fever
Diarrhea
Abdominal pain
Frequency, Dribbling, Urgency, Dysuria
Malodorous urine
Enuresis
Flank pains

Algorithm on Urinary Tract Infection

History
Physical Examination
Urinalysis suggestive of UTI
(+) Leukocyte esterase or Nitrate test,
Bacteuria present in unspun Gramstained specimen
Pyuria > 10/hpf
Urine culture of a properly colected
urine specimen

Algorithm on Urinary Tract Infection

Fever>38.5C
a. ABSENT

Diagnosis
Proper collection of urine
a. Suprapubic tap Infants below 1 y/o
b. Catheterization Alternative
c. Midstream urine Cooperative older
girls, circumsized boys, and older boys
with retractable foreskin

Diagnosis
Initial Urinalysis
a. Gram stain on an uncentrifuged urine
specimen

Sn = 0.93; FPR = 0.05 A/I-II

b. Urine dipstick tests

Sn = 0.88; FPR = 0.04 A/I

c. Pyuria

WBC 5>hpf TPR = 0.67; FPR = 0.21

WBC 10>hpf TPR = 0.77; FPR = 0.11

d. Parallel combinations

Sn = 100%; Sp = 60%

Urine Culture
Gold standard is any bacterial growth after
suprapubic tap
Suprapubic tap (Sp = 89%)
Growth of any pathogen
Exception: Coagulase-negative Staphylococci 2-3 x 10^3
CFU/ml

Catheterization (Sp = 83%)

>50,000 CFU/ml of single urinary pathogen

Midstream clean void

Symptomatic: >10,000 CFU/ml of single urinary pathogen
Asymptomatic: at least 2 specimens on different days
with >10,000 CFU/ml of same pathogen

Diagnosis
Urine Culture using Bag specimen
Sn = 100%; Sp = 14-84% D/II

Ultrasonography
Sn = 95-99%; Sp = 32-55%

 Vesicoureteral reflux
Most common abnormaility found in
patients
Prevalence up to 30-40%

Oral Treatment

Amoxicillin 20-40 mkday in 3 doses

TMP-SMX 6-12/30-60 mkday in 2 doses
Sulfisoxazole 120-15 mkday in 4 doses
Cefixime 8 mkday in 2 doses
Cephalexin 50-100 mkday in 4 doses
Cefpdoxime 10 mkday in 2 doses
Cefprozil 30 mkday in 2 doses
Loracarbef 150-30 mkday in 2 doses

Parenteral Treatment

Ceftriaxone 75 mk every 24 hours

Cefotaxime 150 mkday every 6 hours
Ceftazidime 150 mkday every 6 hoours
Cafazolin 50 mkday every 8 hours
Gentamicin 7.5 mkday every 8 hours
Tobramycin 5 mkday every 8 hours
Ticarcillin 300 mkday every 6 hours
Ampicillin 100 mkday every 6 hours

Prophylaxis of UTI
TMP-SMX 2/10 mkdose ODHS or
TMP-SMX 5/25 mkdose twice per
week
Nitrofurantoin 1-2 mkday OD
Sulfisoxazole 10-20 mkday every 12
hours
Nalidixic acid 30 mkday every 12
hours
Methenamine mandelate 75 mkday
every 12 hours