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Y4R1 - Pediatrics I 👶 > L6: UTI > Flashcards

L6: UTI Flashcards

1
Q

Def of UTI

A

Urinary tract infection (UTI) is defined by the presence of bacteria in bladder urine.

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2
Q

Once the diagnosis of UTI is made, it is important to classify the location and severity of tissue invasion

A
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3
Q

Def of Acute pyelonephritis

A

Infection which involves the bacterial invasion of renal parenchyma

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4
Q

Def of Acute cystitis

A

Infection limited to superficial invasion of the bladder

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5
Q

Def of Asymptomatic bacteriuria

A

Presence of infected urine which produces
no-clinical symptoms

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6
Q

Epidemeology of UTI

A
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7
Q

Classification of UTI

A
  • Acc to severity
  • Acc to Site
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8
Q

Classification of UTI

  • According to severity
A
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9
Q

Classification of UTI

  • According to Site
A
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10
Q

Simple UTI

A

UTI with no fever, dysuria, frequency or urgency

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11
Q

Complicated UTI

A
  • Fever, systemic toxicity
  • Persistent vomiting, dehydration
  • Renal angle tenderness, increased creatinine
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12
Q

Recurrent UTI

A

Second episode of UTI; usually within 6 months

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13
Q

Upper UTI

A
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14
Q

Lower UTI

A
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15
Q

Pathogenesis of UTI

A
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16
Q

Pathogenesis of UTI

  • Causative Organism
A

mostly E.coli

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17
Q

Pathogenesis of UTI

  • Method
A
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18
Q

When to suspect Acute pyelonephritis in Newborn?

A
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19
Q

When to suspect Acute pyelonephritis in Infants & Young Children?

A
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20
Q

When to suspect Acute pyelonephritis in Older Children?

A
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21
Q

When to suspect Acute cystitis in Children > 2 years?

A
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22
Q

DDx of Voiding symptoms in children > 2 years

A
  • Vulvovaginitis (itching + vaginal discharge + inflamed vulva)
  • Pin worm infestation
  • Hypercalciuria
  • Unstable bladder
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23
Q

Host Factors contribuiting to UTI

A

+++ Anatomical factors

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24
Q

Host Factors contribuiting to UTI

  • Age
A

Higer in boys < 1 year & in girls < 4 years

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25
Q

Host Factors contribuiting to UTI

  • Sex
A
  • Females (2-4 folds higher)
  • This may be the result of the shorter female urethra.
    Because the incidence of UTI in male neonates is as high, if not higher, than female neonates
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26
Q

Host Factors contribuiting to UTI

  • Race
A

White children have 2-4 folds higher than black (for not completely understood reasons )

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27
Q

Host Factors contribuiting to UTI

  • Genetic
A
  • Higher in first degree relatives
  • Adherence of bacteria may be genetically determined.
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28
Q

Host Factors contribuiting to UTI

  • dysfunctuinal elimination
A
  • An abnormal elimination pattern (frequent or infrequent voids, urgency, constipation)
  • Bladder and/or bowel incontinence
  • Withholding maneuvers
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29
Q

Host Factors contribuiting to UTI

  • Circumcision
A

(Uncircumcised male infants with fever have 4-8 fold higher prevalence)

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30
Q

Host Factors contribuiting to UTI

  • Catheterization
A

(Increased Risk with Increased duration of bladder catheterization)

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31
Q

Host Factors contribuiting to UTI

  • Anatomical abnormalities
A
  • Urinary obstruction
  • Vesicoureteral reflux
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32
Q

Anatomical abnormalities contributing to UTI

  • Urinary Obstruction
A
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33
Q

Anatomical abnormalities contributing to UTI

  • VUR
A
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34
Q

RF for Renal Scarring

A
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35
Q

CP of UTI in neonates (<28 days)

A
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36
Q

CP of UTI in in children (< 2 years)

A
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37
Q

CP of UTI in Older Children (> 2 years)

A
  • Fever
  • Abdominal pain
  • Urinary symptoms (dysuria, urgency, frequency, incontinence, macroscopic hematuria)
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38
Q

Fever + chills + flank pain —>

A

Pyelonephritis

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39
Q

Abdominal Ex in UTI

A
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39
Q

General Ex in UTI

A
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40
Q

Genital (Local) Ex in UTI

A
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40
Q

Atypical UTI

A
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41
Q

Recurrent UTI

42
Q

Red Flags in UTI

43
Q

Investigations for UTI

A

Labs & Rads

44
Q

Methods of Urine Collection

45
Q

Preservation of Urine

46
Q

Urine Dipstick Analysis

47
Q

Use of Leucocyte Esterase

A
  • Suggestive of UTI
  • However, +ve result doesn’t always signal UTI
48
Q

Test Principle of Leucocyte Esterase

A

-Leukocyte esterase is present in neutrophils and can be assayed in urine by dipstick strips

49
Q

Sensitivity & Specifity of Leucocyte Esterase

A

Sensitivity: 84%

Specifity: 78%

50
Q

False Positive in Leucocyte Esterase

A
  • Imipenem
  • Clavulanic acid
51
Q

False negative in Leucocyte Esterase

A
  • Ascorbic acid
  • Boric acid
  • Gentamicin
  • Nitrofurantoin
  • Cephalexin
  • Proteinuria
  • Glycosuria
  • Urobilinogen
52
Q

Use of Nitrite

A
  • Suggestive of UTI
  • Not identify gram +ve infection (Lack nitrate reductase enzyme)
53
Q

Test Principle in Nitrite

A
  • bacterial enzyme nitrate reductase can convert urinary nitrate to nitrite.
54
Q

Sensitivity & Specificity in Nitrite

A
  • 50%
  • 98% (Highly specific & low false +ve rate)
55
Q

Microscopic Examination in UTI

56
Q

Def of Pyuria

57
Q

Sensitivity of Pyuria

A

Sensitivity is 89 % which means it suggests infection, but infection can occur in absence of pyuria

58
Q

Specifity of Pyuria

A

Presence of WBCs in urine is not specific for UTI as pyuria can be present without UTI

59
Q

Causes of Sterile Pyuria (False Positive)

A
  • Renal TB
  • Urethritis
  • Inflammation near the bladder (appendicitis, Chrons disease)
  • Intestinal nephritis
60
Q

True UTI without +ve leukocyte esterase on dipstick analysis and > 5 WBC/HPF with standardized microscopy is …….

61
Q

Absence of pyuria in presence of significant bacteriuria may occur in …..

A
  • Early in the course of UTI (before the local inflammatory response develops
  • Bacterial contamination of the urine sample (e.g. from the urethra or periurethral)
  • Colonization of the urinary tract (e.g. asymptomatic bacteriuria)
62
Q

Pyuria & Bacteruria association

63
Q

….. is the gold standard for the diagnosis of UTI.

A

Urine culture

64
Q

Urine culture should be performed in the following groups, even if the dipstick and microscopic analysis are negative:

65
Q

Urine culture interpretation in UTI

66
Q

CBC in UTI

67
Q

Read Dx of UTI from Notes

68
Q

Imaging in Dx of UTI

A

To identify abnormalities of the genitourinary tract, including VUR and obstructive uropathies. It Includes:

  • Renal bladder sonography.
  • Voiding cystourethrogram (VCUG)
  • Tc-99m DMSA scintigraphy
69
Q

Indications of Imaging in Dx of UTI

70
Q

Imaging in Dx of UTI

  • Time of US
A

Immediately

71
Q

Imaging in Dx of UTI

  • value of US
72
Q

VCUG in UTI

  • Time
A

3-6 weeks after infection but can be done after completing of antibiotic therapy

73
Q

VCUG in UTI

  • Prophylactic Antibiotics
A
  • Prophylactic oral antibiotics should be given for 3 days with VCUG taking place on the 2nd day
74
Q

VCUG in UTI

  • Uses
74
Q

Technique of Tc-99m DMSA scintigraphy in UTI

75
Q

What is the gold standard test for diagnosing acute pyelonephritis and renal scars?

A

Tc-99m DMSA scintigraphy

76
Q

DMSA in UTI

  • Disadvantages
A

However, it doesn’t distinguish lesions that will spontaneously resolve from those which cause renal scarring

77
Q

DMSA in UTI

  • How to overcome the drawbacks?
A

Thus, a delay of 4 - 6 months is needed following acute pyelonephritis to allow acute reversible lesions to resolve in order to diagnose renal scarring

78
Q

Indications of Imaging in UTI

  • Child < 6 months
79
Q

Indications of Imaging in UTI

  • Child 6m - 3 years
80
Q

Indications of Imaging in UTI

  • Children > 3 years
81
Q

TTT of UTI

  • Goals
82
Q

TTT of UTI

  • General Measures
83
Q

TTT of UTI

  • Hygeinic Measures
84
Q

TTT of UTI

  • TTT Protocol
A
  • Empirical Therapy
  • Early and aggressive antibiotic therapy is necessary to prevent renal damage.
  • It is initiated while awaiting culture results in infants and young children who are at risk for UTI complications and children with underlying urologic abnormalities.
85
Q

TTT of UTI

  • Oral Antibiotics
86
Q

TTT of UTI

  • Parentral Therapy
87
Q

TTT of UTI

  • Other Meds
A

Sulpha combinations (TMP-SMX), amoxicillin, penicillin, or nitrofurantoin.

88
Q

TTT of UTI

  • Duration of Antibiotics
89
Q

TTT of UTI

  • For pyelonephritis
90
Q

TTT of UTI

  • For Cystitis
91
Q

Suppressive Therapy in UTI

  • Indications
A

VUR → Till reflux resolves especially in children < 5 years of age.

92
Q

Suppressive Therapy in UTI

  • Duration
A

Antibiotic prophylaxis is continued for up to 6 months after surgical correction of VUR.

93
Q

Suppressive Therapy in UTI

  • Drugs
94
Q

Suppressive Therapy in UTI
- SE of Cotrimocxazole

A

Avoid in children < 3 months age or G6PD def.

95
Q

Suppressive Therapy in UTI

  • SE of Nitrofurantoin
A
  1. GIT upset
  2. Avoid in children < 3 months age or G6PD def. or renal insufficiency.
96
Q

Suppressive Therapy in UTI

  • Advantages of Cephalixin
A

Drug of choice in 1st 3 months of life

97
Q

Suppressive Therapy in UTI

  • Precautions of Cifixime
A

selected circumstances only

98
Q

DOC for suppressive therapy in UTI in first 3 months of life

A

Cephalexin

99
Q

Prognosis of UTI

A
  • Recurrent UTI
  • HTN
  • Renal scarring
100
Q

Prognosis of UTI

  • Recurrent UTI
A

Approximately 14% of children younger than 6 years with UTI have a subsequent UT.

101
Q

Prognosis of UTI

  • HTN
A

Hypertension can result from renal scar formation in patients who have had acute pyelonephritis, often in association with VUR or another urinary tract anomaly.

102
Q

Prognosis of UTI

  • Renal Scarring
A

Acute pyelonephritis has the potential to cause tubulointerstitial damage and renal scar formation.

Y4R1 - Pediatrics I 👶 (49 decks)

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