Campbell Pediatric GU Infections 2021 Flashcards
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Most common bacterial infection in children
UTIs are the most common bacterial infection in children, accounting for 7% of febrile infections in infants and 7.8% of febrile infections in children older than 24 months.
Significant clinical UTI
Catheterized: 50,000 CFU/mL
Clean-catch: 100,000 CFU/mL
Suprapubic aspiration: recovery of ANY organisms = UTI
AAP 2011 UTI:
UA should suggest infection + 50,000 CFU/mL through catheterization or suprapubic asp.
The first step in UTI pathogenesis
Adherence is considered the first step in UTI pathogenesis with special bacterial structures called adhesins mediating this process.
AKA: Pili or F antigens, and they are filamentous appendages that project from the bacterial cells.
K antigens
The capsules of most uropathic E. coli are composed of group II polysaccharides and are otherwise known as K antigens.
Encapsulated K bacterial strains are less well phagocytosed and also have anticomplementary activities, as compared with nonencapsulated strains, which leads to impaired bacterial clearance and complement activation
The only time UTIs are more prevalent in boys than in girls…
…is at an age younger than 1 year.
At all other ages, even among the elderly, UTIs are far more prevalent in females than in males.
*** 7% of girls and 2% of boys experience a UTI by the age of 6 years
Circumcision and pediatric UTI
Circumcision reduces the rate of UTI development in the first 6 months of life by almost 10-fold.
However, the question of whether circumcision actually prevents infections later in life continues to be debated in the literature.
Clinical studies show that women lacking ____ are at increased risk for vaginal colonization with E. coli.
Vaginal lactobacilli
Exposure to antibiotics, especially trimethoprim-sulfamethoxazole (TMP-SMX), may eradicate these presumably protective lactobacilli.
Recommended in all children aged 2 to 24 months after they have experienced their first febrile UTI.
Renal and bladder US (RBUS)
To detect possible anatomic abnormalities
TRUE or FALSE: Majority of children who have pyelonephritis have VUR.
FALSE.
Although VUR may be present in a child who has suffered a pyelonephritic infection, the majority of children who have suffered from pyelonephritis do not have VUR.
Bladder and bowel dysfunction
Dysfunctional elimination syndrome
- Infrequent voiding
- Incomplete bladder emptying
- Constipation
- Bladder overactivity
Commonly seen for evaluation of recurrent UTIs, daytime/nighttime urinary incontinence, urinary urgency, constipation, encopresis
Affects UTI and VUR
TRUE or FALSE: Treatment of bladder and bowel issues reduces recurrent UTIs and improves VUR resolution.
TRUE.
Treating children suffering from bladder overactivity with anticholinergics alone resulted in VUR resolution or improvement in 44% to 79% of children.
Treatment of children suffering from dysfunctional voiding with biofeedback resulted in VUR resolution in 55% to 63% of cases and improvement in VUR grade after 1 year of therapy
Neurogenic bladder treatment to prevent renal damage from abnormally high pressures causing renal damage and UTIs
Clean intermittent catheterizations facilitate the emptying of the bladders of patients with neurogenic bladder and lower chronic bladder distention and bladder pressure.
CIC and UTI
- 40% to 80% of individuals who intermittently catheterize develop chronic bacteriuria and/ or pyuria and most are asymptomatic
- ASB appears to lack morbidity most of the time
TRUE or FALSE: stopping prophylactic antibiotic in children with spina bifida is associated with reduced bacterial resistance
TRUE
TRUE or FALSE: Children with SB on CIC can undergo urodynamic studies without prophylactic antibiotics.
TRUE
TRUE or FALSE: Sterile, single-use, lubricated catheters reduce the risk of UTI in chronic intermittent catheterization
FALSE.
The use of sterile versus non-sterile, single versus multiuse, and lubricated versus nonlubricated catheters have shown no benefit in reducing the risk of UTI development
Most common nosocomial infection
Catheter-associated UTI (CAUTI) is the most common nosocomial infection, accounting for more than 1 million cases each year in US hospitals and nursing homes
- Increases with catheter duration
- Avoid morbidity with judicious use of catheters, remove when not necessary
Unresolved bacteriuria
Most commonly caused by inadequate bacterial therapy, which could be secondary to noncompliance, antibiotic malabsorption, suboptimal drug metabolism, and resistant uropathogens that were unresponsive to the attempted therapy
Bacterial persistence
After sterile urine has been documented after previous UTI therapy: the nidus causing the infection has NOT been eradicated.
Reinfection
The SAME pathogen is documented on urine cultures during subsequent UTI episodes, despite negative cultures after previous antibiotic treatment.
Asymptomatic bacteriuria
TWO consecutive urine specimens yielding positive cultures (>105 CFU/mL) of the same uropathogen
+
No infection symptoms
TRUE or FALSE: Children with ASB without VUR are at risk for recurrent UTI, renal damage, or impaired renal growth
FALSE.
Children in this age group who are without VUR and/or other genitourinary abnormalities do not require antibiotics to clear their bacteria because they do not appear to be at any risk for recurrent symptomatic infections, renal damage, or impaired renal growth.
Because anti-microbial therapy in these individuals is unlikely to prevent later asymptomatic or symptomatic bacteriuria, and untreated individuals appear to be at low risk of developing long-term sequelae related to the bacteriuria, routine antimicrobial therapy is NOT recommended.
