Urinary tract infection Flashcards
Recurrent UTI definition
2 or more episodes of UTI with upper / acute pyelonephritis in 6 months
1 upper tract and one or more lower in 6 months
Or 3 or more lower UTI in 6 months
atypical UTI features - 7
Seriously ill Poor urine flow Abdominal bladder mass Raised creatinine Septicaemia Failure to respond 48 hours Non E.coli organisms
trimethoprim treatment dose
4mg/kg twice a day
12 yo and above 200mg bd
how common are UTI in children
3-5% of girls 1% of boys by 16, 11% girls and 3% of boy incidence higher in boys than girls in first year 60% vs 20% after 1 yr old females more common
urine sample in children
options are clean catch if can void on command pad sterile in nappy high incidence mixed growth bag - also risk mixed growth SPA
features in history
poor urine flow previous uti or confirmed uti recurrent fever uncertain origin antenatally diagnosed renal abnormality FH of VUR or renal disease constipation dysunctional voiding poor urine flow enlarged bladder abdominal mass spinal lesion poor growth high BP
features atypical UTI 7
palpable bladder not respond 48 hours non ecoli organism sepsis raised creatinine poor urine flow seriously ill
recurrent UTI
2 episodes with one being upper in 6 months
1upper and 1 or more lower tract in 6 months
3 or more lower in 6 months
imaging younger than 6 months
us in acute infection -atypical recurrent
US in 6 weeks - normal UTI responding within 48 hours
DMSA 4-6 months, MCUG yes to atypical and recurrent
imaging 6 months to 3 years
us acute infection atypical only
us within 6 weeks recurrent
DMSA 4-6 months yes to both atypical and recurrent
imaging children more than 3 years
yes us acute infection atypical
yes us 6 weeks recurrent
DMSA recurrent only
imaging
eligible groups
less than 6 months 7
6 months to 3 years - 4
3 year above - 3
why no need us in acute setting recurrent uti in children older than 6 months
in these more likely functional so no need us in acute setting
nice guidance uti prevention
drink fluid
avoid constipation
access clean toilets
bladder assessment for who?
how do?
for recurrent and atypical uti
voiding diary
uroflow
pvr
effect of constipation on bladder
bladder changes shape
more likely bugs on perineum
stretched rectum inhibitory effect on nerves supply bladder
more likely have PVR
how is MCUG done
catheter some radiation special dye x rays taken end of test catheter removed x rays as she urinates
as baby lie on couch with mum
and need wait to urinate
inncidence of renal abnormality found with pyelonephritisi
30%
chance recurrence pyelo
20% in one year
history in recurrent UTI 4
symptoms suggesting significant predisposing pathology
straining to void, poor stream, frank haematuria, neurological, pain
voiding pattern - infrequent voiding, school toilets
fluid intake -avoid fizzy and coloured drinks
bowel
advice for recurrent uti
prompted voiding at least every 3 hours, every school break time treating conspitation fluid intake some evidence cranberry d mannose
child circulating blood volume
75-80mls/kg
prescribing maintenence fluids for child
sodium chloride
sodium chloride with 5% dex
or hartmanns
fluid for child’s weight
up to 10kg 4.ml/kg for first 10kg
10-20 = 2mg/kg for the next 10kg
20+ kg = 1ml/kg /hr for every kg over 20kg
eg 25kg child 65/ml/hr
risk of renal scarring after UTI febrile
2.5% after first febrile UTI
25% after 2
30% after 3
NNT for uti reduction with circumcision
VUR is 4
rUTI is 11
PUV McCarthy paper - reduced by 83%
