paediatric infection

Question 1

4 m.o. boy brought to casualty with a short hx of vomiting and fever. after seeing him, you decide that he needs a full sepsis screen.

(a) give the most reliable method for obtaining an uncontaminated sample of urine from this boy

Answer 1

clean-catch mid-stream specimen

Question 2

(b) give 2 other appropriate methods of obtaining urine from infants

Answer 2

1. catheter specimen
2. supra-pubic aspiration

Question 3

(c) name 2 other parts of the sepsis screen which you would perform to identify the infection in an infant

Answer 3

1. culture
   
   • blood, urine and CSF (if not contra-indicated) for culture and sensitivity
2. microscopy
   
   • urine and CSF (if not C/I)
3. bloods
   
   • WCC / ESR / CRP
4. imaging
   
   • CXR

Question 4

(d) 48 hours after admission, microbiologist informs you that the lab is in the process of isolating a bacterium from the urine.

what 2 standard criteria are used to define a lab culture dx of UTI?

Answer 4

1. pyuria positive/negative
2. bacteriuria positive/negative

Question 5

(e) what is the usual organism which is obtained from a +ve urine culture in this setting?

Answer 5

Escherichia coli

Question 6

(f) the urine infection is confirmed and the infant is treated with IV abx for 7 days. he improves steadily over this time.

what rx should he receive on discharge pending further ix?

Answer 6

prophylactic abx

Question 7

(g) what single imaging ix would you request for him at follow-up?

Answer 7

within 6 weeks of UTI, an US of the urinary tract should be performed to identify structural abnormalities

• _{DMSA (identify renal abnormalities) cannot be performed until 4-6 months following the acute infection}
• _{MCUG should only be performed in atypical or recurrent UTI}