PEDs infectious diseases- UTI

Question 1

Risk factors of UTI

Answer 1

Girls
white race, age <12M, fever > or equal to 39, fever > or equal to 2 days, absence of another source of infection

Boys
nonblack race, temp > or equal to 39, fever > or equal to 24 hours, uncircumcised, absence of another source of infection

Question 2

Signs and symptoms for newborns, infants, school-aged children

Answer 2

Newborns
jaundice, sepsis, failure to thrive, vomiting, fever

Infants
fever, strong smelling urine, hematuria, abdominal/flank pain. new onset urinary incontience

school aged children
symptoms similar to adults

Question 3

Methods of urine collection- EXAM Q

Answer 3

Clean catch - used in older patient groups

Catheterization - preferred for <24 months age group -EXAM Q

Urinalysis: Urine Dipstick - Leukocyte esterase, nitrate (when both positive it means UTI present)

Question 4

Urine Microscopy

Answer 4

More expensive
evaluates WBCs, RBCs, and bacteria in sample

Pyuria = >5-10 WBCs per uL

Bacteruria = any bacterial per uL

Question 5

Urine culture

Answer 5

SPA: >10,000 CF/ml

Catheter specimen: >10,000 CFU/ml

Clean catch: >100,000 CFU/mL

Question 6

Treatment considerations

Answer 6

Oral and IV equally efficacious

Use IV for patient who are hemodynamically unstable or cannot retain oral intake

Can change to oral therapy when patient has clinical improvement - usually within 24-48 hours

Question 7

Duration of therapy

Answer 7

7-14 days for ages 2-24 months
10-14 days for pyelonephritis
3-7 days for cystitis in older female patients

Question 8

Treatment options

Answer 8

Cephalexin First line
Q6H or Q8H

Amoxicillin not as common due to resistance

Amoxicillin/Clavulanate

SMX/TMP
oral suspension Q12H