Urinary tract infections Flashcards
What are UTIs?
Infections of the urinary tract
At what age do UTIs occur?
Any age
What are UTIs caused by?
Micro-organisms in the urinary tract
Which microorganisms commonly cause UTIs?
E.coli (>85%)
Klebsiella species
Staphylococcus saprophyticus
List the 3 types of UTI
Upper
Lower
Undifferentiated
What do lower UTIs affect?
Urethra and bladder (cystitis)
What do upper UTIs affect?
Renal pelvis and kidneys (pyelonephritis)
What is an undifferentiated UTI?
When you are unable to distinguish between Upper and lower
List some risk factors for UTI in children
Age <1yo Female (after >3months) Caucasian Previous UTI Voiding dysfunction Vesicoureteral reflux (VUR) Sexual abuse Spinal abnormalities Constipation Immunosuppression
List the clinical features from the history of a UTI in infants <3months
Vomiting Fever Lethargy Poor feeding Failure to thrive Abdo pain Jaundice Haematuria Offensive smelling urine Irritability
List the clinical features from a history of a UTI in children who can verbalise
Increased frequency Painful urination Dysfunctional voiding Incontinence Abdo pain Loin tenderness Vomiting Fever Malaise Haematuria Offensive smelling urine Cloudy urine
What should be gained from examination of a child with a fever?
Temperature
Heart rate
Respiratory rate
Capillary refill time
Give the clinical signs when acute pyelonephritis/Upper UTI should be suspected in a child?
Temperature of 38 or higher and bacteriuria
Temperature lower than 38 with loin pain/tenderness and bacteriuria
When should a lower UTI be considered?
No systemic symptoms but bacteriuria present
What should be examined when suspecting UTI?
Throat and cervical lymph nodes
Abdomen - constipation, masses, tender or palpable kidney
Back - stigmata of spina bifida or sacral agenesis
Genitalia - phismosis, labial adhesions, vulvitis, epidymo-orchitis
List the differential diagnosis of a UTI
Vulvovaginitis Kawasaki disease Voiding dysfunction Sepsis with no urinary tract source Threadworms Meningitis
What investigations are required and when for UTI?
Clean catch urine sample for microscopy and culture within 24 hours in all infants with unexplained temp >38
Urine dipstick if UTI suspected
What other methods can be used when clean catch is unobtainable
Urine collection pads
Catheter samples
Suprapubic aspiration
What will a urine dipstick show if UTI is present?
Positive for Leukocyte esterase and nitrites
What imaging is required for children under 6 months with a UTI?
Typical UTI - Ultrasound within 6 weeks
Atypical UTI - Ultrasound during acute infection, Dimercaptosuccinic acid (DMSA) 4-6 months after infection, micturating cystourethrogram (MCUG)
Recurrent UTI - Ultrasound during acute infection, DMSA 4-6 months after, MCUG
What imaging is required for patients older than 6 months with a UTI?
Typical UTI - No imaging
Atypical UTI - Ultrasound during infection and DMSA 4-6months after
Recurrent - DMSA 4-6 months after and MCUG
List some features of an atypical UTI
Poor urine flow Abdominal or bladder mass Raised creatinine Sepsis Failure to respond to treatment within 48hrs Non E.col organism
Define recurrent UTI
> 2 episodes or upper UTI
1 episode of upper UTI and one episode of lower UTI
Three episodes of lower UTI
What information does ultrasound give of the kidneys
Size, congenital abnormalities, renal calculi, hydro nephrosis, obstruction, reflux
What information does micturating cystography give?
Gold standard investigation for reflux and provides info about the urethra
What are the problems with micturating cystography?
Invasive and requires catheterisation
What is DMSA scintigraphy gold standard for detecting?
Renal parenchyma defects and scarring
Describe the management of a child <3months old with suspected UTI
Refer to paediatric specialist for urine analysis and treatment with parenteral antibiotics
Describe the management of children >3months with lower UTI
Oral antibiotics for 3 days - trimethoprim, nitrofurantoin, cephalosporin, amoxicillin (choose according to local guidelines)
Advise parents to return if child still unwell 24-48hrs later
Describe the management of a child >3 months with upper UTI
Referral to paeds specialist considering:
- Age
- How unwell child is - can they tolerate oral ABx?
- Inadequate fluid intake 50-75% usual volume/no wet nappy >12hrs
- Factors indicating parent can not look after child/recognise deterioration
If admission not appropriate then oral antibiotics, ciprofloxacin or co-amoxiclav for 7-10 days
How should asymptomatic bacteriuria be managed?
No antibiotics
What advice should be given to parents of a child with a UTI
Complete full course of ABx Paracetamol for pain relief Adequate fluid intake Not to delay voiding Have access to clean toilet Constipation should be addressed Symptoms of UTI and safety netting
List some complications of UTI
Renal scarring/damage/ insufficiency/failure
Hypertension
Possible link between bacteriuria and hypertension in pregnancy in future with history of childhood UTI
When is recurrence of UTIs more likely?
Children <6months
Girls compared to boys
VUR grade 3-5
Voiding abnormalities
Describe vesicoureteral reflux
Reflux of the urine from the bladder into the ureter
Affects a third of children with UTI
Can be uni/bilateral
