Infections

Question 1

What are the common organism that lead to sepsis by age?

Answer 1

Neonates:
- 0-5 days from vertical transmission is GEL (group B strep, E. coli, Listeria)
- 5-28 days it is GEL + staph or strep
Infants <3months: 
- GEL, gram negative bacilli, staph
Children >3months: 
- strep pneumonia
- neisserria meningitides
- H flu type B when greater than 3 years
- indwelling catheter coagulase negative staph

Question 2

What are some risk factors for sepsis in neonates?

Answer 2

Maternal infection/fever
Chorioamnionitis
Prolonged rupture of membranes (>18 hours)
Preterm delivery

Question 3

List the differential for sepsis in children

Answer 3

Infection:
- CNS: meningitis
- Respiratory: pneumonia 
- GI
- GU: UTI
- MSK: septic arthritis
- Heme: bacteremia
Metabolic: hypoglycemia
Child abuse
CNS: seizure
Cardiac: congenital heart disease, arrhythmia 
GI: volvulus, pyloric stenosis, necrotizing enterocollitis
Toxins

Question 4

Discuss the empiric antibiotic therapy for a child with sepsis

Answer 4

Newborns (<6 weeks):
- ampicillin IV and Gentamicin or Tobramycin
Infant (6weeks to 3 months):
- ampicillin + cefotaxime (cloxacillin if risk for Staph)
Children (>3 months):
- ceftriaxone and vancomycin

Question 5

What are the risk factors for meningitis?

Answer 5

Immune compromised: 
- premature
- asplenia
Neuroanatomical defect: 
- dermal sinus
- neurosurgery
Para-meningeal infection: 
- sinusitis
- mastoiditis
- orbital cellulitis
Environmental: 
- daycare, household contact
- if contact with meningicoccus require rifampin, ciprofloxacin, and ceftriaxone for 2 days
- if contact with h flu type B and unvaccinated require rifampin for 4 days

Question 6

What is the pathophysiology and what are the most common pathogens for meningitis?

Answer 6

URTI damages mucosa -> bacteremia -> seeding of infection on meninges -> CNS inflammation

Infants (0-3 months): 
- GEL
- gram negative bacilli
- HSV
Children (>3 months): 
- strep pneumo
- neisseria meningitides
- h flu type B (>5)
- HSV

Question 7

Discuss the management of meningitis in pediatrics

Answer 7

Management IV Antibiotics:

• <3 months Amp + cefotaxime + vancomycin
• > 3months ceftriaxone + vancomycin
• acyclovir IV for HSV
• Dexamethasone with 1st Abx to decrease ICP
• control ICP: elevate head of bed to 30 degrees, control blood pressure, IV mannitol if pupils non-reactive or ICP >20

Question 8

Discuss some of the acute and chronic complications of meningitis in children

Answer 8

Acute:
- SIADH -> hyponatremia and brain edema
- empyema or brain abscess
- septic shock
- DIC
Chronic:
- hearing loss
- intellectual disability
- seizure disorder

Question 9

What are the risk factors for a UTI in children?

Answer 9

• boys <6 months or <12 months and uncircumscribed
• girls of all age, <1 year highest risk
• <1 boys>girls, >1 girls»boys
• immune compromised or diabetes
• vesicouteral reflux or voiding dysfunction
• wiping back to front

Question 10

List the common pathogens for a UTI

Answer 10

E. Coli is the most common

PPEEEAKS

• proteus
• pseudomonas
• E. coli
• enterococcus
• enterobacter
• Acinebacter
• Kliebsella
• Staph saprophyticus

Question 11

Discuss the presentation and management of UTI in children

Answer 11

Presentation:
- Newborns: fever, failure to thrive, jaundice, vomiting
- Cystitis: frequency, urgency, dysuria, suprapubic pain, incontinence, hematuria
- Pyelonephritis: fever, malaise, nausea/vomiting, CVA tenderness
Investigations:
- Dipstick: leukocyte esterase very sensitive, nitrites very specific
- Urine culture and sensitivity
- Urine routine and microscopy
Management:
- Uncomplicated (no fever or abnormalities): cephalexin or Septra for 5-7 days
- Complicated (fever but stable and no abnormalities): cefixime PO for 7-14 days or single gentamicin IM/IV until culture results
- Complicated inpatient or Pyelonephritis (fever, reason for hospitalization, or <2):
- 0-2 months ampicillin and gentamicin 5 days IV then PO for total of 10-14 days
- >2 months ampicillin and gentamicin until afebrile x48hours then PO for total of 10-14 days

Question 12

List the indications for hospitalization for a UTI

Answer 12

Age <2 months
Urosepsis
Pyelonephritis
Immune compromised
Intractable vomiting
Failure to respond to outpatient therapy

Question 13

Discuss when you would perform an ultrasound of the bladder and kidney for a child with a UTI

Answer 13

<2 years with first febrile UTI
Recurrent febrile UTI
Family history of urological/renal disorder, poor growth or hypertension
Do not respond to antimicrobial therapy

Question 14

Discuss the indications for a voiding cystourethrogram to assess VUR in children

Answer 14

> =2 febrile UTIs

Febrile UTI + anomalies on renal ultrasound, fever >=39 with pathogen other than E. coli, poor growth, hypertension