Urinary tract infection Flashcards
Urinary tract infection (UTI) = infection anywhere from kidney to the urethra.
In children UTI prompts investigation for possible underlying cause and damage to kidneys.
What are the causative organisms for UTI?
- E. coli (80% of cases)
- Proteus
- Pseudomonas
What are the predisposing factors for UTI in children?
- Incomplete bladder emptying:
=> infrequent voiding
=> hurried micturition
=> obstruction by full rectum due to constipation
=> neuropathic bladder
- Vesicoureteric reflux
=> developmental anomaly found in 35% of children with UTI - Poor hygiene
=> e.g. not wiping from front to back in girls
What are the clinical features in babies under 3 months (infants)?
- Poor feeding
- Vomiting
- Irritability
- Failure to thrive
- Fever
- Lethargy
- Offensive urine
What are the clinical features in babies 3-12 months?
- Fever
- Poor feeding
- Abdominal / flank pain
- Vomiting
- Febrile convulsions
- Foul smelling urine
- Diarrhoea
What are the clinical features of UTI in children >1 year old (toddlers)?
- Frequency
- Dysuria
- Abdominal pain
* fever is less common >1year
What are the clinical features of UTI in children >1 year old (toddlers)?
- Frequency
- Dysuria
- Abdominal pain
* fever is less common >1year
What are the clinical features of UTI in older children?
- Dysuria
- Frequency
- Haematuria
- Flank pain
- Vomiting
- Foul smelling urine
Which features suggest an upper UTI in children?
Temperature >38
Loin pain / tenderness
NICE guidelines for checking urine sample in a child:
- Any symptoms or signs suggestive of a UTI
- Unexplained fever >38 (test urine after 24h at the latest)
- Alternative site of infection but who remain unwell (consider urine after 24h at the latest)
What is the urine collection method in children?
- Clean catch preferable
- If not possible then urine collection pads should be used
- Cotton wool balls, gauze and sanitary towels not suitable
- Invasive methods i.e. suprapubic aspiration only used is non-invasive method not possible
How is UTI diagnosed in children?
- Positive leukocytes and nitrites on urine dip
- Positive urine culture with appropriately collected urine (clean catch, non-contaminated collection pad/catheter sample/suprapubic aspirate)
What is the management of UTI in children?
- Oral antibiotics suffice in most cases unless suspicion of upper UTI or urosepsis
* pregnancy test should be done in females of reproductive age to avoid teratogenic antibiotics - Antibiotics should be guided by urine culture sensitivities
=> lower UTI = nitrofurantoin for 3 days
=> upper UTI = cephalosporin for 7-10 days
i) Infants <3mnths => referred to paediatric immediately ; IV amoxicillin + gentamicin or IV cephalosporin + ampicillin
ii) Children aged >3mths with upper UTI should be considered for hospital admission
=> if not, prescribe oral cephalosporin or co-amoxiclav for 7-10 days
iii) Children >3mths with lower UTI treated with oral antibiotics for 3 days (usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin - use local guidelines)
=> Safety-net: parents bring back children if unwell after 24-48hours
=> antibiotic prophylaxis with recurrent UTI considered
Follow-up imaging:
- Ultrasound scan:
=> helps identify structural abnormalities
=> only needed if patient has atypical UTI - Dimercaptosuccinic acid (DMSA) scintigraphy scan: checks for scarring
=> should not be done until 4 months after UTI - Micturating cystourethrogram (MCUG)
=> assess for abnormal bladder function
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What is considered an atypical UTI?
- Poor urine flow
- Abdominal or bladder mass
- Raised creatinine
- Septicaemia
- Failure to respond to treatment with suitable antibiotics within 48 hours
- Infection with non-E. coli organisms
Follow ups:
Children with recurrent UTIs should be referred to secondary care for further investigation, especially babies who have faltering growth
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