GU - UTI Flashcards
Defintion
UTIs in children usually result of bacteria ascending to the bladder via the urethra -> cystitis.
From the bladder, infection can ascend to the kidneys resulting in pyelonephritis
Epidemiology
Age: children <12
Male < 3 months due to increased risk of congenital urinary abnormalities
Female > 3 months
White
Risk factors
Previous UTI
Voiding dysfunction: inability to empty the bladder increases the risk of UTI. This includes structural abnormalities, voluntary withholding of urine and chronic constipation
Vesicourecteric reflux (VUR): reflux of urine from the bladder into the ureter during voiding. It can be unilateral or bilateral, and increases the risk of pyelonephritis and renal scarring
Immunosupression
Aetiology
Escherichia coli (MC)
Klebsiella
Proteus,
Pseudomonas
Streopoccocus faecalis
Classification of UTIs
Lower UTI: Involves the bladder (cystitis) and urethra (uthethritis)
Upper UTI: ureters and kidneys (pyelonephritis)
Uncomplicated UTIs: occuring in a structurally and neurologically normal urinary tract
Complicated UTIs: associated with structural and neurological abnormality
Atypical UTI
defined by the presence of any of the following features (remembered by the mnemonic “CATFISH”):
- Creatinine raised
- Abdominal or bladder mass
- Terribly ill
- Flow of urine poor
- Infection non-E.coli
- Sepsis
- Halted response to Abx >48 hours
Recurrent UTIs
2 or more episodes of upper UTIs
OR
1 episode of upper UTI and 1 or more episdoes of lower UTI
OR
3 episodes of lower UTIs
Signs
Fever
Suprapubic tenderness
Flank tenderness (in pyelonephritis)
Symptoms
Dysuria
Frequency
Lower abdominal pain
New onset bedwetting
Vomiting
Loss of appetite
Diagnosis
FIRST LINE =
- Urinalysis: useful screening tool in children > 3 months
- If nitrates and leukocytes +ve: treat as UTI
- If nitrates and leukocytes are -ve : UTI is unlikely
- If nitrates +ve but leukocytes -ve: treat as UTI and send urine for microscopy and culture
- If nitrates -ve but leukocytes +ve: send urine for microscopy and culture. Treat as UTI in children < 3 year or if there is clinical evidence of a UTI
GOLD STANDARD = Urine MC+S
- Identify causative organism
- In children wearing nappies, clean catch urine (CCU) is preferable however this must not delay treatment
- USS KUB = Any child with first presentation of UTI under 6 months or any age with recurrent UTIs to check for nephroagenesis or VUR
Consider doing: - Micturating cystourethrogram (MCUG): indicated in children with vesicoureteric reflux
- Dimercaptosuccinic (DMSA) acid renal scan:
= children >3 with recurrent UTI
= children < 3 with atypical UTI
Treatment
Antibiotic therapy: children <3 months are admitted to hospital for IV antibiotics. Older children that do not otherwise require hospital admission can be treated with oral antibiotics:
Upper UTI:
FIRST LINE = CO-AMOXICLAV or CEFALEXIN, pending culture results.
Lower UTI:
FIRST LINE = IV CEFUROXIME
Infants and children on prophylactic antibiotics should be treated with an alternative antibiotic.
Analgesia: regular paracetamol for pain relief
Fluids: encourage fluid intake to promote urinary output
Complications
Recurrent UTIs
Renal scarring
Sepsis
Extended-spectrum beta-lactamases (ESBLs)
Enzymes that confer resistance to most beta-lactam antibiotics, including penicillins, cephalosporins
- TREATMENT: MEROPENAM