pediatric UTI Flashcards
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
Most common causative pathogen
E. Coli
4 infection pathways
1.) Retrograde ascent (most common)
2.) Nosocomial infection
3.) Hematogenous route
4.) Fistula (rare)
Retrograde ascent
bacteria enter through urethra and migrate to bladder
Nosocomial infection
bacteria introduced via foreign body (catheter) to the urinary tract
- generally more resistant pathogens
Hematogenous route
systemic infection with subsequent UT seeding
- more common in infants and immunosuppressed patients
Fistula
between UT and GI/vagina
- rare
Cystitis
Lower UTI
infection site: bladder
Urethritis
Lower UTI
infection site: urethra
Pyelonephritis
Upper UTI
infection site: kidney
Complicated vs Uncomplicated UTI
Complicated: structural/functional abnormalities or catheters
Uncomplicated: none of the above
Signs and symptoms of UTI in neonates
- jaundice
- failure to thrive
- fever
- difficulty feeding
- irritability
- vomiting and diarrhea
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
Signs and symptoms of UTI in children > 2 years old
- fever
- frequency
- dysuria
- enuresis
- hematuria
- abdominal pain
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
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
