Infections: UTI and AOM Flashcards
What is the general flow of UTI likelihood in children?
Females > uncircumcised males > circumcised males
What presentation indicates a likely UTI?
Children <12 who present with fever
What is retrograde ascent?
Pathogens entering through the urethra and migrating to the bladder
What is nosocomial infection?
Introduction of foreign body to the UT (catheters for example) -> more resistant organisms
What are s/s of UTI in neonates?
- Jaundice
- Weight gain
- Fever
- Difficulty feeding
- Vomiting/diarrhea
- Irritability
What are s/s of UTI in children <2?
Similar to neonates
- Without jaundice
- Cloudy/malodorous urine
- Hematuria, frequency, dysuria
What are s/s of UTI in children >2?
- Fever
- Hematuria, frequency, dysuria
- Abdominal pain
- Enuresis (accidents)
T/F: Rapid urine tests may not be used to replace urine cultures for diagnosis.
TRUE
What is the gold standard for UTI diagnosis?
Suprapubic aspiration (SPA)
Since SPA is invasive and not commonly preferred, what other methods are commonly used for diagnosis?
- Transurethral catheterization
- Clean catch (unreliable)
What is diagnostic criteria for UTI?
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
What is first line treatment for UTIs?
Cephalosporins
Bactrim
B-lactam/B-lactamase inhibitor
When is parenteral treatment required for UTI?
- Sepsis
- Infants <2 months
- Immunocompromised
- Unable to tolerate PO
-> continue until stable and afebrile
What is the treatment duration for uncomplicated UTI?
7 days
What is the treatment duration for pyelonephritis?
14 days
What is VUR?
Urinary backflow from bladder to ureters or kidneys (1% incidence)
What is the estimated prevalence of VUR in febrile children with UTI?
25-40%
What are risk factors for VUR?
- Febrile UTI
- Parent/sibling with VUR
- Prenatal hydronephrosis
What are complications of VUR?
- Recurrent UTI
- Renal scarring
- HTN
How can VUR be dealt with?
Observation (typically resolves within 4-5 years)
Antibiotic prophylaxis
Surgery
Who might be candidates for UTI prophylaxis?
- 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
Based on current evidence, who should be considered for UTI prophylaxis?
- Females
- VUR grade IV/V
- Bladder dysfunction
How long should UTI prophylaxis last?
1-2 years (“outgrown”) or until surgically repaired
What UTI prophylaxis is preferred for neonates/infants <2 months?
Amoxicillin
What UTI prophylaxis is preferred for infants >2 months?
Bactrim or nitrofurantoin
What should we generally avoid for UTI prophylaxis (drug-wise)?
Cephalosporins (resistance)
What is uncomplicated AOM?
AOM without otorrhea
What is non-severe AOM?
AOM with the presence of mild otalgia AND temperature <39C
What is severe AOM?
AOM with the presence of moderate to severe otalgia OR fever >39C
What is recurrent AOM?
- 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
What is the second most common pediatric diagnosis in the ED?
AOM
What is the peak age of incidence for AOM?
6-12 months
T/F: Males are at slightly higher risk for AOM and 80% of all children will have AOM at least once in life
TRUE
What are the 3 most common bacteria that cause AOM
- S. pneumoniae
- H. influenzae
- Moraxella catarrhalis
What are risk factors for AOM?
- Genetics/hereditary
- Allergies
- Lack of breastfeeding
- Low socioeconomic status
- Passive smoke exposure
- Daycare attendance
- Pacifier use
- Winter season
What is the hallmark s/s for AOM?
Otalgia -> pulling/tugging ear
What is the diagnostic criteria for AOM?
- 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
What is the treatment recommendation for children >2 years with mild AOM symptoms?
Watchful waiting
Besides mild AOM children >2 years, when else can watchful waiting be considered?
Patients 6 months - 2 years with UNILATERAL AOM and NO otorrhea
When should antibiotics be considered during AOM watchful waiting?
48-72 hours if symptoms are persistent or worsening
What is first-line treatment for AOM?
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
What alternative first line treatments can be given to AOM patients with a penicillin allergy?
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
How long should a child <2 be treated for AOM?
10 days of amoxicillin
How long should a child >2 be treated for AOM?
5-7 days possible
What analgesics can we consider for AOM
Ibuprofen 5-10 mg/kg/dose Q6H PRN (only 6+ months old)
Acetaminophen 10-15 mg/kg/dose Q4-6H PRN
What procedure can be done for those with recurrent AOM?
Tympanostomy tubes
