URIANRY TRACT INFECTIONS Flashcards by Qúophy Calbert

UTI can progess to the following infections

Pyelonephritis
Urosepsis

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Why do neonates present with nonspecific symtoms in UTI

UTIs in neonates are due to hematogenous rather than ascending infection

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Where does UTI generally begin from after the neonatal period

The bladder with ascending disease to the kidneys

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Bacterial invasion of the bladder with overt UTI symptoms is more likely to occur if……….

Urinary stasis or low flow conditions exist

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Effect of circumcision on UTI

Uncircumcised males> Circumcised males

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UTI prevalence in different sexes

Neonates: males>females
Above neonatal period: females>males

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Risk factors for UTI

Bacterial virulence
Host factors

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factors in bacteria that increases their virulence in UTIs

Antigen K
Presence of fimbriae

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Host factors that predispose to UTI

Anatomical
Functional
Immunologic

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Causes of UT obstruction

Phimosis
Meatal stenosis
Posterior urethral valve disorder
Diverticuli
Ureteric stricture or kink
Claculi

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Anatomical host risk factors of UTI

Vesicoureteral reflux
Abnormal insertion of ureters in the bladder
UT obstruction
Indwelling catheter

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Meatal stenosis

Narrowing of the opening at the end of the penis (the external urethral opening or meatus)

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Phimosis

A condition in which tight foreskin cannot be pulled back over the head of the penis

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Posteriori urethral valve

Obstructive valves that develop in the urethra close to the bladder, obstructing urine outflow

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Symptoms of UTI in neonates

Jaundice
Hypothermia or Fever
Failure to thrive
Poor feeding
Vomiting

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Functional host risk factors of UTI

Neurogenic bladder in spina bifida
Inappropriate detrusor muscle contractions

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Symptoms of UTI in infants

Poor feeding
Fever
Vomiting
Diarrhoea
Strong-smelling urine

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Symptoms of UTI in preschoolers

Vomiting
Diarrhoea
Abdominal pain
Fever
Strong-smelling urine
Enuresis
Dysuria
Urgency
Frequency

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Difference between UTI symptoms in preschoolers and school age children

Preschoolers - diarrhoea
School age children- flank pain

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Symptoms of UTI in school age children

Fever
Vomiting
Abdominal pain
Strong-smelling urine
Dysuria
Frequency
Urgency
Flank pain
New enuresis

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Hypertension in UTI raises suspicion of…..

Hydronephrosis
Renal parenchyma disease

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Most common cause of UTI

E. coli

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Causative agents of UTI

(FASKEEP)
Fungi in immucompromised patients
Adenovirus
S. aureus
Klebsiella spp
Enterocossus spp
E. coli
Proteus spp

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Differentials of UTI

Sepsis
Falciparum malaria
GIT disorders
Renal calculi
Urethritis
Vaginitis
Vulvovaginitis

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Physical examination in UTI

Costovertebral angle tenderness Abdominal tenderness or mass Palpable bladder Examine external genitalia Dribbling, poor stream or straining to void

Urinalysis diagnosis of UTI

Urine positive for nitrite, leukocyte esterase or blood

Which investigations can urine bag specimen be used for

Specific gravity Chemical parameters Not for culture

Microscopic examination of urine in UTI shows:

Presence of WBC(>5 per high-power field) RBC Bacteria Casts Epithelial cells

When is bag specimen used for UTI investigations in neonates and infants

If the urine bag is removed immediately after urine is collected

Urine sample collection in UTI

Midstream in adults Bladder puncture in neonates and infants

Classic criteria for UTI

A clean-catch urine sample with more than 100,000 CFU of a single organism If the specific gravity of the urine was low, 60,000-80,000 CFU may be significant.

When is lower colony counts significant

If present on a repeat culture

Why is urine collected in bags not suitable for culture

Due to high incidence of contamination

How to obtain better results from bag specimen

1. Clean and dry perieum before placing bag 2. Remove collected urine as soon as patient voids

Which level of CFU from bladder catheterization is considered significant for UTI

10,000 pure CFU/ml

Which level of CFU from suprapubic aspiration is considered significant for UTI

>1000 CFU/ml

Increased BUN in a child older than 2 months raises suspicion for

Hydronephrosis Renal parenchyma disease

Imaging studies in UTI

1. Renal ultrasound 2. Voiding cystourethrogram (VCUG)

Role of renal ultrasound in UTI

Depicts Kidney size and shape

limits of renal ultrasound

Poorly depicts ureters No information on function

Role of VCUG

1. Depicts Urethral and bladder antomy 2. Detects vesicoureteral reflux (VUR)

Standard criterion for urine sample collection in UTI investigations

Suprapubic tap

Most invasive diagnostic procedure in UTI invetsigations

Suprapubic tap

Diagnostic procedure for patients who cannot provide a midstream clean-catch urine sample

Catheterization of the bladder Suprapubic bladder aspiration

When is a urologist consulted at patient presentation

Evidence of urinary tract obstruction

When is short course therapy used

Adolescent females with evidence of cystitis

Recommended duration of antibiotic treatment in UTI

10 days

Why is short course therapy not used on children

It is more difficult to differentiate between cystitis and pyelonephritis`

Which route of antibiotics is used for febrile UTI in young infants and children according to recent evidence and why

Oral antibiotics Because Short term(fever) and long term (pyelonephritis) outcomes are comparable to parenteral therapy

Which UTI patients require aggressive management in ER

Septic or toxemic patients

Route of antibiotics for cystitis and pyelonephritis

Cystitis- oral Pyelonephritis- parenteral

Cystitis vs pyelonephritis

Cystitis: infection of bladder and urethra Pyelonephritis: Infection of kidney

Antibiotics used in UTI

5C-GAN Cefotaxime Cephalexin Cefixime Ciprofloxacin Co-trimoxazole Gentamicin Amoxicillin Nalidixic acid

Amoxicillin dose

Paediatrics: IV/IM 100-200mg/kg/day divided q6hrs

Amoxicillin is usually combined with......

Gentamicin or Cefotaxime

Gentamicin dose

<5yrs: 2.5mg/kg/dose IV/IM q8hrs >5yrs: 1.5-2.5mg/kg/dose IV/IM q8hrs

Which antibiotic used as initial therapy for paediatrics with acute pyelonephritis?

Cefotaxime

Which antibiotic is used for neonates or jaundiced patients?

Cefotaxime

Cefotaxime dose

Paediatrics: 100-200 mg/kg/day in divided doses q6-8hrs

Spectrum of Co-trimoxazole

Common UTI pathogens ecxept P. aeruginosa

Dose for co-trimoxazole

>2months: 5-10 mg/kg/day PO divided q12hours, based on TMP content

Dose for Cephalexin

Paediatric: 25-50mg/kg/dose PO q6h, max-3g/day

Dose for cefixime

Paediatric: 8mg/kg/dose PO qd: max:400mg/day

Oral antibiotics used in UTI in paediatrics

Cephalexin Cefixime Co-trimoxazole

Parenteral antibiotics used in UTI in paediatrics

Ampicillin Cefotaxime Gentamicin

Contraindications to nalidixic acid

G6PD, causes hemolysis

Why is nalidixic acid used in UTI

it has minimal distribution in tissues and is excreted mainly through the kidneys and reach high concentration in urine

When is ciprofolxacin used

Second line or for recurrent UTI

Most common complication of UTI

Dehydration

Long term complications of UTI

Renal parenchyma scarring Hypertension Decreased renal function Renal failure