Urinary Tract Infections Flashcards
Complications of UTIs
Recurrent UTIs
AKI
ESRD (hypertension, dialysis, renal transplantation)
Main pathogen causing UTI
E. Coli
Risk factors for UTI
Younger age groups (neonates/infants)
Female sex
Uncircumcised infants
Constipation
Anatomic abnormalities (VUR)
Functional abnormalities (neurogenic bladder)
Female sexual activity
Immunocompromised state (HIV, transplant)
Diabetes mellitus
Genetic predisposition
Infection pathways for UTI
Retrograde ascent
Nosocomial infection (foreign body)
Hematogenous route
Fistula
Classification of UTI by infection site
Lower UTI:
Bladder = cystitis
Urethra = urethritis
Upper UTI:
Kidney = pyelonephritis
Urine = bacturia
Classification of UTI by complication
Complicated: GU tract with structural/functional abnormalities, catheters
Uncomplicated:
Occurs in anatomically normal UT with no prior instrumentation
Bacterial persistence UTI
Documentation of negative urine cultures after UTI treatment, however because of incomplete eradication the original infecting organism is isolated on subsequent episodes. Usually occurs with underlying abnormalities.
Signs and symptoms of UTI
Neonates: Jaundice, FTT, fever, difficulty feeding, irritability, vomiting and diarrhea
Infants and children < 2 years: Cloudy or malodorous urine, hematuria, frequency, dysuria
Children > 2 years: Fever, frequency, dysuria, enuresis, hematuria, abdominal pain
Diagnosis of UTI
Urine culture
SPA is the gold standard but invasive. Clean catch and transurethral catheterization is more utilized
Rapid urine tests are not intended to replace urine culture as a diagnostic tool
Definition of UTI
Significant bacturia + pyuria
>100,000 cfu/mL in clean catch
>50,000 cfu/mL in catheterization
Treatment of UTI
First line: cephalosporins, TMP/SMX, b lactam and b lactamase inhibitor
Parenteral: Acutely ill (septic) children, infants < 2 months, immunocompromised, unable to tolerate PO. Continue until afebrile and clinically stable.
Duration of UTI treatment
Uncomplicated UTI: 7 days
Complicated UTI/pyelonephritis: 10-14 days
UTI prophylaxis candidates
Neonates/infants being evaluated for anatomic or functional UT abnormalities
Children with VUR
Children with dysfunctional voiding
Immunocompromised
Children with recurrent UTIs despite normal anatomy/function
Prophylactic medications continued until the resolution of underlying predisposing conditions
UTI target populations
Females
VUR Grade V
Bladder/bowel dysfunction
Take for 1-2 years or until outgrown or surgically repaired
UTI prophylactic medications
Neonates/infants </= 2 months: Amoxicillin
Infants > 2months: Nitrofurantoin or TMP/SMX
