pediatric UTI Flashcards by Marissa Hovey

Risk factors for development of UTIs in children

female
uncircumcised male
younger age groups (neonates/infants)
constipation
anatomic abnormalities (vesicoureteral reflux - VUR)
functional abnormalities
female sexual activity
immunocompromised
diabetes
genetic predisposition

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Most common causative pathogen

E. Coli

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4 infection pathways

1.) Retrograde ascent (most common)
2.) Nosocomial infection
3.) Hematogenous route
4.) Fistula (rare)

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Retrograde ascent

bacteria enter through urethra and migrate to bladder

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Nosocomial infection

bacteria introduced via foreign body (catheter) to the urinary tract
- generally more resistant pathogens

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Hematogenous route

systemic infection with subsequent UT seeding
- more common in infants and immunosuppressed patients

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Fistula

between UT and GI/vagina
- rare

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Cystitis

Lower UTI
infection site: bladder

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Urethritis

Lower UTI
infection site: urethra

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Pyelonephritis

Upper UTI
infection site: kidney

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Complicated vs Uncomplicated UTI

Complicated: structural/functional abnormalities or catheters

Uncomplicated: none of the above

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Signs and symptoms of UTI in neonates

jaundice
failure to thrive
fever
difficulty feeding
irritability
vomiting and diarrhea

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Signs and symptoms of UTI in infants and children < 2 years old

-failure to thrive
- fever
- difficulty feeding
- irritability
- vomiting and diarrhea
- cloudy or malodorous urine
- hematuria
- dysuria

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Signs and symptoms of UTI in children > 2 years old

fever
frequency
dysuria
enuresis
hematuria
abdominal pain

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UTI definition

Significant bacturia + pyuria
- clean catch: > 100,000 cfu/ mL of 1 bacteria
- catheterization: > 50,000 cfu/mL of 1 bacteria
- suprapubic aspiration: any growth of bacteria

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First line UTI treatments

cephalosporins
TMP/SMX
b lactam/ b lactamase inhibitor

parenteral administration in patients:

septic
< 2months old
immunocompromised
unable to tolerate PO

Duration of therapy

Uncomplicated UTI = 7 days
Pyelonephritis = 10-14 days

Ampicillin dosing

IV: 100-200 mg/kg/day divided Q 4-6H

Cefazolin (1st gen) dosing

IV: 50 mg/kg/d divided Q6-8H

Cefotaxime (3rd Gen) dosing

IV: 100-150 mg/kg/d divided Q6-8H

Ceftriaxone (3rd gen) dosing

IV: 50-75 mg/kg/d divided Q12-24H
- avoid in neonates: biliary sludging

Ceftazidime (3rd gen) dosing

IV: 100-150 mg/kg/d divided Q8H

Cefepime (4th gen) dosing

IV: 100 mg/kg/d divided Q12H

Ciprofloxacin dosing

IV: 18-30 mg/kg/d divided Q8H -ADE: tendon rupture, tendonitis PO: 20-40 mg/kg/d divided Q12H

Gentamicin dosing

IV: 5-7.5 mg/kg/d divided Q8-24H - nephrotoxicity / ototoxicity

Tobramycin dosing

IV: 5-7.5 mg/kg/d divided Q8-24H - nephrotoxicity / ototoxicity

Amox/Clav dosing

PO: 40-50 mg/kg/d divided Q8-12H

Cephalexin (1st gen) dosing

PO: 50 mg/kg/d divided Q6H

Cefixime (3rd gen) dosing

PO: - 8 mg/kg/dose Q12H x 1 day - 8 mg/kg once daily

Cefpodoxime (3rd gen) dosing

PO: 10 mg/kg/d divided Q12H

Ceftibuten (3rd gen) dosing

PO: - 9 mg/kg/dose Q12H x 1 day - 9 mg/kg once daily - serum sickness rxn

Nitrofurantoin dosing

PO: 5-7 mg/kg/d divided Q6H - urine discoloration

TMP/SMX dosing (based on TMP)

PO: 8-12 mg/kg/d divided Q12H - hematologic AE - interstitial nephritis - avoid in infants < 2 months

Vesicoureteral Reflux (VUR)

retrograde urinary flow from bladder into ureters and possibly renal collecting system and renal pelvis - grades I-V

Target populations for UTI prophylaxis

- females - VUR grade IV or V - bladder/bowel dysfunction

UTI prophylaxis in neonates/ infants 2 months old or younger:

Amoxicillin - 10-15 mg/kg once daily

UTI prophylaxis in infants > 2 months

Nitrofurantoin - 1-2 mg/kg once daily TMP/SMX - 2 mg/kg once daily - 5 mg/kg twice weekly