pediatric UTI Flashcards
2nd most common infection in children
UTI
incr risk of renal scarring assc’d with which bacteria?
any bacteria other than E coli
what ages are at higher risk for UTI?
boys younger than 1 yr
girls younger than 4 yrs
what is a complication of UTI causing HTN, proteinuria, and renal failure
renal scarring
urine sample: when to get for girls and uncircumcised boys under 2 yrs
when present with at least 1 risk factor
urine sample: when to get for circumcised boys under 2 yrs
suprapubic tenderness or at least 2 risk factors
urine sample: when to get for girls and uncircumcised boys > 2 yrs
when present with any urinary sx
urine sample: when to get for circumcised boys > 2 yrs
when present with multiple urinary sx
risk factors for UTI (7)
- abd pain
- back pain
- fever and no other apparent source
- ill appearing
- suprapubic tenderness
- fever>24 hrs
- non-Af Am
gold standard for UTI
urine culture
what is urosepsis
- toxic appearence
- hypotension
- poor cap refill
when do UTI in neonates usu present
2nd-3rd week
incidence of UTI in neonates is ____more in uncircumcised that circumcised
10x
best method for urine culture in neonates
suprapubic aspiration
most common bugs for UTI in preterm infants (2)
- Coag neg Staph
2. klebsiella
most common bugs for UTI in term infants (1)
E coli
is preterm or term more likely to have hematagenous spread?
preterm infants more likely to have sepsis
term infants are more likely to have____ than ______
pyelonephritis (ascending)» hematogenous spread
tx of neonate UTI
IV ampicillin + gentamycin 10-14 days
tx of pediatric UTI
3rd gen cephalosporins + aminoglycosides
when to give oral meds
if age >2 months, not vomiting, family close
how long to tx with oral meds
3-5 days
f/u if failure to improve or worsening after 48 hrs
- add amoxicillin
- obtain renal and bladder U/S
- urine culture
when to give prophylactic Abx for recurrent UTI
if 3 febrile UTIs in 6 months, or 4 in 1 yr
prophylactic tx for recurrent UTI
TMP-SMX or nitrofurantoin as single doses for 6 mon
most common urologic finding in children
vesicourethral reflux
vesicourethral reflux is more common in which grps (3)
- white kids
- girls
- younger than 2 yrs
what is the most common form of reflux
primary VUR
VUR due to incompetent closure of ureterovesical jxn
primary VUR
VUR due to abnormally high pressure in bladder resulting in failure of closure
secondary VUR
what grade of VUR: Reflux only fills ureter without dilation
grade 1
Reflux fills ureter and collecting system without dilation
grade 2
Reflux fills and mildly dilates ureter and collecting system with mild blunting of calyces
grade 3
Reflux fills and grossly dilates ureter and collecting system with blunting of calyces. Some tortuosity of ureter also present
grade 4
Massive reflux grossly dilates collecting system. All calyces are blunted with loss of papillary impression, and intrarenal reflux may be present. There is significant ureteral dilation
grade 5
test of choice for dx of VUR
voiding cysturethrogram (VCUG)
when if VCUG indicated
- kids with 2+ febrile UTI
2. kids with 1 febrile UTI and other risk factors
presents as constipation, daytime wetting, frequency and urgency
bladder and bowel dysfxn
