GU- UTI Flashcards
Most frequent pathogen
E-coli
how many percent of children yearly?
2.4%
up to 6 months old which gender is more common?
males
incidence in males <6 months
2 per 100 births
what is the increased risk to uncirc males <6 months old ?
tenfold!
more common in famales after what age?
1 year
what percent of toilet trained females get UTI?
3%
what percent of children with UTI develop renal scarring?
15%
10-20% of kids with renal scarring will develop
hypertension
symptoms in infants
fever, irritability, poor feeding, vomiting, diarrhea
suspect when no other source of fever or illness present
symptoms in older children
dysuria, suprapubic/urethral pain, urinary frequency, incontinence
foul smelling urine and constipation- always get stool history
s/s if kidney is involved
fever, flank pain, nausea, vomiting
in infants with gross anatomic abnormalities such as obstruction
may detect a mass
physical findings
CVA tenderness
external irritation r/t incont, vaginal voiding, labial adhesions
diagnosis that are misdiagnosed as UTI
vaginitis
pinworms
both present frequently with dysuria
What to do if vaginal discharge is present
culture
What do we rule out in older males?
scrotal exam to r/o epididymis especially if sexually active
What are you looking for on ABD exam?
large stool burden, constipation is common
What patients need US?
First positive uti with fever and systemic illness
infants, febrile UTI’s, recurrent UTI’s, children not toilet trained,
Must document true infection via cath sample to decide what additional evaluation is needed (if doing xrays)
bagged specemin
helpful in r/o UTI
if positive: need cath sample
False positives in 90% especially if left on >20 min
clean-catch
better- small colony counts of multiple orgamisns suggests contamination
difficuly for children to perform even with parents help, urine hits perineum first, difficulty separating to wipe first
cath specimen
Most widely accepted technique
some offices not able to perform
urinalysis provides
lueks
nitrates (positive highly suggestive of infection)
culture assesses
colony count
what pathogens
suceptability to atb
suprapubic aspirate
most reliable
rarely used d/t anxiety of needle use to parent and child
Who provides guidelines for treatment of UTI’s?
UK National Institute for healthy and clinical experience (NICE) and
the AAP
when so we perform renal US?
if child is not responding to therapy- promptly
What do we consider if renal US is abnormal?
VCUG or DMSA
urinary tract obstructions are seen in what percent
5-10%
vesicoureteral reflux in what percent?
21-57 of patients with obstruction
when to refer?
positive testing for reflux/obstruction
febrile UTI
Lab tests
only done in significantly ill, febrile child
Elevated creatinine or BUN indicates
urinary tract problem
elevated WBC on CBC indicates
infection
Who should be hospitalized?
infants who appear systemically ill or are < 3months old
choice for parenteral atb
third gen cephalosporins
aminoglycosides
therapy lasts 7-14 days
Management of young children that are ill appearing at home
must have confidence in family
approved for complicated UTI/pyleonephritis but concern for safety in children - use situational and limited
Quinilones
when can parenteral treatment be stopped?
may change to PO after clinical picture is improving and sensitivity on culture returns
not good choice for systemically ill patient, doesnt reach high serum concentrations
Nitrofurantoin
Uncomplicated UTI described as
lower urinary tracy or bladder infections
legnth of atb for uncomplicated UTI
3-5 days oral atb
oral treatment of choice prophylaxis
Nitrofurantion - high urinary concentration
Nitrofuration prophylactic dose
1-2 mg/kg single daily dose
expensive and liquid is poorly tolerated
sprinkle capsules in yogurt, applesauce
TMP-SMX prophylactic dosage
2mg/kg once per day or
5mg/kg twice per week <1 month
age for keflex and amplcillin
newborns
Treatment of choice for uncomplicated UTI, PO
TMP-SMX (bactrim)
AmmoxCluv (Augmentin)
second or third gen cephalosporin
legnth of atb if febrile or 2-24 months
7-10 days
Bactrim dose - first line treatment
8 to 12mg/kg trimethoprim
30-60mg/kg sulfamethoxazole
in two divided doses
bactrim age
greater than 2 months old
Cultures
acute UNCOMPLICATED pylonephritis treatment options for young children
Oral cefixime
ceftibuten
ammox/clauv
acute UNCOMPLICATED pylonephritis treatment options for adolescents option 1 and dose
ammox-clauv (augmentin) PO
875/125 mg BID
acute UNCOMPLICATED pylonephritis treatment options for adolescents option 2 and dose
Cipro 500mg BID or ER 1000mg daily
Admission criteria for “complicated” pyelonephritis- req IV atb
less than 1 months old
vomiting
not drinking
dehydration concerns
tylenol
10-15 Q4-6
max 5 doses in 24 hours
motrin
5-10 Q6 hrs
not to exceed 40mg/day
choose one
phenazopyridine
ages and doses (2)
12mg/kg/day 6-12 years old
200mg TID >12 years old
foods to aviod
caff, carb beverages, choc, citrus, aspartame, alcohol, spicy foods
when to follow up
48-72 hours after starting treatment
what if response to appropriate atb was ineffective?
repeat culture in 48-72 hours
if reocurrant treatment problems get culture 3-7 days after atb completed
follow up for children <2 years old
febrile UTI, recurrent UTI, pyelonephritis
Who needs a VCUG scan?
second febrily UTI
child with sibling with VUR
history of maternal UTI
neurogenic bladder
BBD
neonates and VCUG
neonates with complex medical conditions may have scan after first episode of pylonephritis to assess renal scarring
infection of bladder leading to lower uti - no renal injury or fever
cystitis
bacteria in urine w/o other symptoms, benign, no renal injury
asymptomatic
most severe uti, renal parychema or kidneys involved
may cause irreversible renal damage
pyelonephritis
complicated UTI
with fever, toxicity or dehydration
child < 3-6 months old
VUR, abnormalities
most important risk factor for developing pyelo
VUR
10-45% of children with symptomatic UTI
most common time for UTI
infancy and toilet training
also at onset of sexual activity in females
Most common cause of fever wihtout focus in less than 24 months
UTI
how are UTIs identified
first occuance
reoccurent (within two weeks, same or different organism)
chronic- ongoing or unresolved
diagnosis of UTI from clean catch sample
>100,000 colonies of single pathogen
diagnosis of uti from cath or suprapubic sample
50,000 colonies
diagnosis of uti in symptomatic child
>10,000 colonies of single pathogen
UTI < 5 years chart
uncomplicated cystitis
out pt
PO ATB
repeat culture 48-72 hours
sterile=complete atb,
if not sterile repeat c/s and treat
repeat culture 3-4 days p atb dome
US and VCUG if indicated when sterile (up to 6 weeks)
UTI <5 years chart
uncomplicated pyelo
(febrile, >3-6 months, well hydrated, no vomiting, no abd pain)
out pt
PO/IM ATB
repeat culture 48-72 hours
sterile=complete atb,
if not sterile repeat c/s and treat
repeat culture 3-4 days p atb dome
US and VCUG if indicated when sterile (up to 6 weeks)
UTI < 5 years
complicated pyelo
(febrile, <3-6 months, toxic, dehydrated, and/flank pain, vomiting)
in pt
IV ATB
repeat culture 48-72 hours
sterile and stable= discharge home
if not sterile repeat c/s and treat
repeat culture 3-4 days p atb dome
US and VCUG if indicated when sterile before d/c, after atb completion or up to 6 weeks as long as child is on pruphylactic atb until test done
Infants 2-24 months
for diagnosis should have suggestive ua (positive nitrates, lueks) followed by urine culture from sterile cath with >50,000 cfu/ml
Bactrim dose adolescents
(uncomplicated cystitis)
160 mg of tmp componend Q12 (TMP cpmponent)
augmentin dose <3 months
(uncomplicated cystitis)
30mg/kg/day two divided doses
augmentin dose >3 months
(uncomplicated cystitis)
20-45mg/kg/day 2-3 divided doses
augmentin dose adolescents
(uncomplicated cystitis)
250-500 Q8 or
875 Q12
nitrofurantoin > 1 month
(uncomplicated cystitis)
> 1 month- 5-7mg/kg/day divided Q6
max 400mg in 24 hours
DMSA
to detect renal scars or parenchymal inflammation changes in the kidney, done 6 months after infection when inflammatory changes in the kidney have resolved
IVP
done if further definition of structure or function is needed - rare
asymptomatic bacturea does not need treatment if
there are no leukocytes
Nitrofurantoin adolescents
(uncomplicated cystitis)
adolescents 50-100mg/dose Q6 or
100mg BID (dual release)
Ammoxicillin < 3 months
(uncomplicated cystitis)
20-30mg/kd/day two divided doses
ammoxicillin > 3 months old
(uncomplicated cystitis)
25-50mg/kg/day two divided doses
Ammoxicillin adolescents
(uncomplicated cystitis)
250-500mg Q8 hrs or
875mg BID
Bactrim > 2 months old
cephalexin
(uncomplicated cystitis)
50-100 mg/kg/day given Q6
max dose 4g/day
cefixime >6 months old
(uncomplicated cystitis)
16mg/kg/day two divided doses
max 400mg/kg/day
cefpodoxime proxetil 2 months - 12 years
(uncomplicated cystitis)
10mg/kd/day two divided doses
max 400mg/kg/day
cefixime adolescents
(uncomplicated cystitis)
400mg Q12-24 hours
cefpodoxime proxetil
adolescents
(uncomplicated cystitis)
200-800mg/day two divided doses
max 800mg/day
ciprofloaxcin ER
(uncomplicated cystitis)
<18 years old
once daily X3 days
acute pyelo treatment choices in young children
(uncomlicated)
cefixime
ceftibuten
augmentin
acute pyelo in adolescent treatment choices
(uncomplicated)
augmentin 875/125 BID
Cipro 500mg BID
or cipro 1000mg ER daily
Cephalexin prophylactic dose
10mg/kg single daily dose
Ammox prophylactic dose
10mg/kg single daily dose
can use in newborns/premies
cant use past 2 postnatal months
liquid good for 14 days
