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704 Pediatrics > Infections: UTI and AOM > Flashcards

Infections: UTI and AOM Flashcards

1
Q

What is the general flow of UTI likelihood in children?

A

Females > uncircumcised males > circumcised males

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2
Q

What presentation indicates a likely UTI?

A

Children <12 who present with fever

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3
Q

What is retrograde ascent?

A

Pathogens entering through the urethra and migrating to the bladder

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4
Q

What is nosocomial infection?

A

Introduction of foreign body to the UT (catheters for example) -> more resistant organisms

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5
Q

What are s/s of UTI in neonates?

A
  • Jaundice
  • Weight gain
  • Fever
  • Difficulty feeding
  • Vomiting/diarrhea
  • Irritability
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6
Q

What are s/s of UTI in children <2?

A

Similar to neonates
- Without jaundice
- Cloudy/malodorous urine
- Hematuria, frequency, dysuria

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7
Q

What are s/s of UTI in children >2?

A
  • Fever
  • Hematuria, frequency, dysuria
  • Abdominal pain
  • Enuresis (accidents)
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8
Q

T/F: Rapid urine tests may not be used to replace urine cultures for diagnosis.

A

TRUE

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9
Q

What is the gold standard for UTI diagnosis?

A

Suprapubic aspiration (SPA)

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10
Q

Since SPA is invasive and not commonly preferred, what other methods are commonly used for diagnosis?

A
  • Transurethral catheterization
  • Clean catch (unreliable)
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11
Q

What is diagnostic criteria for UTI?

A

Significant bacturia + pyuria
- Clean catch >100,000 cfu/mL of one bacteria
- Catheter: >50,000 cfu/mL of one bacteria
- SPA: any growth of bacteria

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12
Q

What is first line treatment for UTIs?

A

Cephalosporins
Bactrim
B-lactam/B-lactamase inhibitor

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13
Q

When is parenteral treatment required for UTI?

A
  • Sepsis
  • Infants <2 months
  • Immunocompromised
  • Unable to tolerate PO

-> continue until stable and afebrile

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14
Q

What is the treatment duration for uncomplicated UTI?

A

7 days

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15
Q

What is the treatment duration for pyelonephritis?

A

14 days

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16
Q

What is VUR?

A

Urinary backflow from bladder to ureters or kidneys (1% incidence)

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17
Q

What is the estimated prevalence of VUR in febrile children with UTI?

A

25-40%

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18
Q

What are risk factors for VUR?

A
  • Febrile UTI
  • Parent/sibling with VUR
  • Prenatal hydronephrosis
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19
Q

What are complications of VUR?

A
  • Recurrent UTI
  • Renal scarring
  • HTN
20
Q

How can VUR be dealt with?

A

Observation (typically resolves within 4-5 years)
Antibiotic prophylaxis
Surgery

21
Q

Who might be candidates for UTI prophylaxis?

A
  • Neonates/infants evaluated for anatomic or functional UT abnormalities
  • Children with VUR
  • Children with dysfunctional voiding
  • Immunocompromised
  • Children with recurrent UTIs and normal anatomy/function
22
Q

Based on current evidence, who should be considered for UTI prophylaxis?

A
  • Females
  • VUR grade IV/V
  • Bladder dysfunction
23
Q

How long should UTI prophylaxis last?

A

1-2 years (“outgrown”) or until surgically repaired

24
Q

What UTI prophylaxis is preferred for neonates/infants <2 months?

A

Amoxicillin

25
Q

What UTI prophylaxis is preferred for infants >2 months?

A

Bactrim or nitrofurantoin

26
Q

What should we generally avoid for UTI prophylaxis (drug-wise)?

A

Cephalosporins (resistance)

27
Q

What is uncomplicated AOM?

A

AOM without otorrhea

28
Q

What is non-severe AOM?

A

AOM with the presence of mild otalgia AND temperature <39C

29
Q

What is severe AOM?

A

AOM with the presence of moderate to severe otalgia OR fever >39C

30
Q

What is recurrent AOM?

A
  • 3 or more well-documented and separate AOM occasions in past 6 months
    OR
  • 4 or more episodes in the past 12 months with at least 1 in the past 6
31
Q

What is the second most common pediatric diagnosis in the ED?

A

AOM

32
Q

What is the peak age of incidence for AOM?

A

6-12 months

33
Q

T/F: Males are at slightly higher risk for AOM and 80% of all children will have AOM at least once in life

A

TRUE

34
Q

What are the 3 most common bacteria that cause AOM

A
  • S. pneumoniae
  • H. influenzae
  • Moraxella catarrhalis
35
Q

What are risk factors for AOM?

A
  • Genetics/hereditary
  • Allergies
  • Lack of breastfeeding
  • Low socioeconomic status
  • Passive smoke exposure
  • Daycare attendance
  • Pacifier use
  • Winter season
36
Q

What is the hallmark s/s for AOM?

A

Otalgia -> pulling/tugging ear

37
Q

What is the diagnostic criteria for AOM?

A
  • Moderate to severe bulging of TM
    OR
  • New onset of otorrhea that is not caused by otitis externa
    OR
  • Mild bulging of TM with recent ear pain or erythema
38
Q

What is the treatment recommendation for children >2 years with mild AOM symptoms?

A

Watchful waiting

39
Q

Besides mild AOM children >2 years, when else can watchful waiting be considered?

A

Patients 6 months - 2 years with UNILATERAL AOM and NO otorrhea

40
Q

When should antibiotics be considered during AOM watchful waiting?

A

48-72 hours if symptoms are persistent or worsening

41
Q

What is first-line treatment for AOM?

A

Amoxicillin 80-90 mg/kg/day in 2 divided doses
OR
Augmentin: 90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate

42
Q

What alternative first line treatments can be given to AOM patients with a penicillin allergy?

A

Cefdinir 14 mg/kg/day in 1 or 2 divided doses
OR
Cefuroxime 30 mg/kg/day in BID
OR
Cefpodoxime 10 mg/kg/day in BID

OR

Ceftriaxone 50 mg IM or IV QD

43
Q

How long should a child <2 be treated for AOM?

A

10 days of amoxicillin

44
Q

How long should a child >2 be treated for AOM?

A

5-7 days possible

45
Q

What analgesics can we consider for AOM

A

Ibuprofen 5-10 mg/kg/dose Q6H PRN (only 6+ months old)
Acetaminophen 10-15 mg/kg/dose Q4-6H PRN

46
Q

What procedure can be done for those with recurrent AOM?

A

Tympanostomy tubes

704 Pediatrics (6 decks)

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