URINARY TRACT INFECTION

(UTI)

Syarifuddin Rauf

Bagian Ilmu Kesehatan Anak

Fakultas Kedokteran Unhas/
Perjan RS Wahidin Sudirohusodo
DEFINITION

Infection from renal parenchyme  orificium

urethrae externa

Significant bacteriuria

With or without symptoms

1
Significant bacteriuria

Pathogenic bacteria

Colony count : > 100.000/ml urine

> 1x lab. examinations

2
Relapsing UTI : Recurrent UTI

Same microorganism

Reinfection UTI : Recurrent UTI

Different microrganism

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INCIDENCE

One of the most common bacterial disease

in children

Asymptomatic UTI > Symptomatic UTI

Age incidence : since birth  school age

Neonatal UTI : boys > girls

Preschool & school age : girls > boys

4
ETIOLOGY
Bacteria :
E. Coli
Klebsiella
Proteus
Pseudomonas
Other microorganisms :
Protozoa
Virus 5
Table 1. Sex ratio of UTI in various age

AGE ♀:♂

0 – 1 month 0,4

2 – 6 month 1,5

7 – 12 month 4

2 – 3 year 10

4 – 11 year 9
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CLASSIFICATION
Clinically : 1. Symptomatic UTI
2. Asymptomatic UTI
Complication :
A. Simple UTI : No abnor. anat. struct.
No complication
B. Complicated UTI :
Abnormal anat. struct. +
Complication : Sepsis
Localization : 1. Upper UTI
2. Lower UTI
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PATHOGENESIS

1. Hematogenic

2. Percontinuitatum

3. Lymphogenic

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DIAGNOSIS
Clinically :
1. Upper UTI (Pyelonephritis) :

Fever, back/flank pain & with or

without lower UTI symptoms

2. Lower UTI (Cystitis) :

Suprapubic punction, dysuria,

frequent voiding etc. 9

PATHOGENESIS

Neonates Baby & Child

(>1 month)

Colonization on GIT

o : Periurethra/Perineum
Hematogen Percontinuitatum +
Certain focus
(Septicemia) (“Ascending”) o : Subpreputium
?

Bacteria enter to
Urinary tract

Symptomatic UTI Asymptomatic UTI

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LAB. EXAMINATIONS
URINE :
1. Urinalysis : Leukocyte > 5-10/HPF
Erythrocyte : +/-
2. Urine culture :
a. Mid : stream urine :
C.C. : > 100.000/ml urine
b. Catheterization :
C.C. : > 10.000/ml urine
c. Suprapubic punction :
C.C. : > 1000/ml urine
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BLOOD :

Leucocytosis

Increased BSR (> 30 mm/hour)

Increased CRP (> 30 ug/ml)

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MANAGEMENT
1. Eradicate acute infection

2. Detection, prevention, & treatment

recurrent infection

3. Detection & surgical correction

abnormality of anatomical structure

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 UTI

R/a.b
Until 7 days………………… 1 st day
(Sulfon, tetracycl, ampicill, trimeth, sulf)

Urine Culture (UC) ……………. 2nd/3rd day

Sensitivity Test (ST)

UC (+) UC(-)

R/ appropriate with ST R/ until 7 days

ST and ST …………. 2 – 3 days

After R/a.b
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 UC and ST …………. 2 – 3 days
After R/a.b

IVP/MCU  Relaps Reinfection UC (-)

R/ a.b. 7-10 days

Appropriate with UK and ST Recover

Freq. Reinf. Infreq, Reinf

Anomaly of UT (+)  Surgery R/ UTI

Anomaly of UT (-)  R/ Nitrofurantoin
6 month

• Anomaly of UT (+)
 Surgical Correction
Control : every month : the 1st 3 month
• Anomaly of UT (-)
every 3 month : the 1st year
 Nitrof. 12 month
every year
 Any
Questio
n?