Pediatric UTIs

Question 1

Risk factors (girls)

Answer 1

White
Age < 12 months
Temp ≥ 39 C
Fever ≥ 2 days
Absence of another infection

Question 2

Risk factors (boys)

Answer 2

Uncircumcised
White
Temp ≥ 39 C
Fever ≥ 2 days
Absence of another infection

Question 3

Pathogenesis

Answer 3

Retrograde ascent
Nosocomial infection
Hematogenous
Fistula formation

Question 4

Common pathogens

Answer 4

E.coli
Klebsiella

Question 5

Presentation

Answer 5

Newborn: jaundice, sepsis, failure to thrive, vomiting, fever

Infants/young children: fever, foul smelling urine, hematuria, abdominal flank pain, new onset urinary incontinence

School-aged children: dysuria, frequency, urgency

Question 6

Diagnosis

Answer 6

Evaluate all febrile children < 24 months

Preferred: catheterization + urinalysis
- < 1 hour if voiding room temp
- < 4 hour if voiding refrigerated
Second: supra-pubic aspiration–>invasive

Question 7

1st line treatment

Answer 7

Cephalexin q6-8h

Question 8

Alternatives

Answer 8

Augmentin

Bactrim q12h: concentrations well in urine, dosed based on trimethoprim

FQ: resistance is a major concern–>pseudomonas
- When to use: MDR pathogens, IV not feasible, no other effective oral agent
- Do not give Cipro through feeding tube, prior authorizations

Question 9

NO NITROFURANTOIN

Question 10

Duration of treatment

Answer 10

2-24 months–> 7 days
Pyelonephritis–>10-14 days
Older, female–>3-7 days

Question 11

Follow-up

Answer 11

Renal/bladder ultrasound and voiding cystography
- all boys
- girls < 3 years old
- girls 3-7 with fever > 38.5 C

Ultrasound only for 2-24 months

Question 12

Urine culture

Answer 12

SPA: > 10,000 CF/mL
Catheter specimen: > 10,000 CFU/mL
Clean catch: > 100,000 CFU/mL