الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
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SUMMARY AND CONCLUSION
U.T.I. is one of the most common infectious problem among infancy
and childhood. It may be acute, chronic or recurrent. Recurrent U.I.I. may
be a relapse or reinfection, but the majority of cases are due to reinfection.
There are several predisposing factors that favour infection, the
most common are : V.U.R., bilharziasis, protein energy malnutrition,
congenital anomalies and non circumcision in males, less common
predisposing factors include obstructive lesions, instrumentation,
metabolic disorders, residual urine and constipation.
The ascending route of infection is by far the most common route
especially in females and uncircumcised male infants. The haematogenous
route is more common in neonates.
E-coli is the most common organism responsible for U.I.I. in
infants and children, followed by klebsiella, Enterobacter, proteus and
staphylococcus. Virus and mycoplasma playa minor role in U.I.I.
U.T.I. 111 neonates present usually by septicemia, jaundice,
hypothermia or C.N.S. manifestations. In infants the most common
presentation is failure to thrive, fever or malodourous urine.
The urine collection can be done by suprapubic aspiration. The
morning sample is prefered as it is the most concentrated one. It is
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important to notice that antibiotic treatment should be discontinued for
sufficient time before collection of urine specimen.
The diagnosis of U.T.I. is based on quantitative documentation of
significant bacteriuria.
Pyuria is a non specific finding, and its demonstration can not
replace urine culture in the diagnosis ofU.T.I. also a normal urine analysis
including a normal white cell count can not exclude the diagnosis ofU.T.!.
The radiologic evaluation includes plain x-ray, renal ultrasound,
I.-V.P. and readionuclide renal scanning.
Excess fluid intake, adequate emptying of the bladder, male
circumcision, breast feeding and correction of congenital anomalies of
urinary tract are effective measures in the prevention ofU.T.I.
Therapy for children with U.T.I. should be adequate and prompt to
prevent or at least minimize the kidney damage and other complications.
The treatment of U.T.I. is based on the results of culture and sensitivity
tests, but the initial treatment is based on the age and clinical assessment
of the patient. In infants less than 6 months and children at any age with
suspected pyelonephritis an intravenous antibiotic therapy should be
started immediately by combination of ampicillin and garamycm or a
cephalosporin fo the second or third generation.
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To detect the effectiveness of treatment, urine culture should be
obtained after 3 days, and follow up urine culture should be done to detect
relapce.
Long term prophylaxis is reserved for those children with frequent
recurrences or who have urinary tract abnormalities.