Exam 1 - Pediatric UTI

Question 1

UTIs are most common in infants

Answer 1

UTIs are most common in infants <60 days with fever 100.4 F

Question 2

UTI considerations in boys and girls

Answer 2

Boys: common less than six months old (high risk if uncircumcised)

Girls: common more than six months

Question 3

Two common causative pathogens of UTI

Answer 3

• E. coli
• Klebsiella

Question 4

Things to consider when obtaining HPI for UTI in infants

Answer 4

• Potential irritating exposures
• Bowel and bladder dysfunction
• Signs of pyelonephritis

Question 5

UTI: history components

Answer 5

• PMH
• Family history
  
  • Vesicoureteral reflux
• Social history
  
  • Use of irritants?
  • Sexually active?

Question 6

UTI: physical exam

Answer 6

• Temperature
• Skin - diaphoretic? dehydrated?
• HEENT
• Neck - check lymph nodes
• Abdomen - N/V?
• Back - CVA tenderness
• Rectal
• Pelvic exam (if sexually active)

Question 7

Diagnostic testing: indications for urine culture

Answer 7

• Acute pyelonephritis suspected
• High to intermediate risk of serious illness
• Age <3 months (immature immune system)
• Positive leukocyte esterase or nitrate testing
• Lack of correlation (UA neg but symptoms pos)
• Recurrent UTI
• No response to treatment

Question 8

Diagnosis: labs collected for presumed UTI diagnosis

Answer 8

UA (+ leukocytes, may have blood)

Question 9

Diagnosis: labs collected for definitive diagnosis

Answer 9

Urine sample (sterile in and out catheter or aspirating suprapubic sample)

Question 10

Can you treat UTIs in infants empirically?

Answer 10

Yes, while waiting for culture

• UTI = bactrim
• Pyelonephritis = amoxicillin-clavulanate

Question 11

When should the FNP consider follow up for infants with UTIs?

Answer 11

• If recurrent
  
  • Need renal and bladder ultrasound to assess for hydronephrosis