URINARY TRACT INFECTIONS Flashcards
In the first 3 months of life, are boys or girls more likely to develop an UTI?
Boys
Between the ages of 3 and 12 months, are boys or girls more likely to develop an UTI?
Equal
After the first year of life, are boys or girls more likely to develop an UTI?
Girls
What percentage of girls will have a UTI in childhood?
Up to 8%
What percentage of boys will have a UTI in childhood?
Up to 2%
What are the clinical features of UTI in infancy?
Poor feeding
Vomiting and diarrhoea
Irritability
Failure to thrive
(Jaundice in very young and neonates)
What are the clinical features of UTI in younger children (1-5 years)?
Abdominal pain
Dysuria
Fever
Malaise
Nocturnal enuresis
What are the clinical features of UTI in older children (older than 5 years)?
Dysuria
Frequency
Haematuria
Fever
Loin pain
What is the organism most commonly responsible for UTI in children?
E. coli originating from bowel flora
Apart from E. coli, what are the organisms commonly responsible for UTI in children?
Proteus - especially in boys
Klebsiella
Pseudomonas
Enterococcus sp
What is the most common factor predisposing a child to UTI?
Urinary stasis
What are the important causes of urinary stasis in a child which might therefore predispose them to having a UTI?
Vesicoureteric reflux
Obstructive uropathy eg ureterocoele, urethral valves
Neuropathic bladder eg spina bifida
Habitual infrequent voiding and constipation
What are the NICE guidelines surrounding which children should have a urine sample checked?
Signs and symptoms of UTI
Unexplained fever of 38˚C or higher
Alternate site of infection but who remain unwell despite treatment
What is the are the different methods of collective urine samples for lab tests and which is the prefered method?
Clean catch is prefered method
If not obtainable then bag or pad sample
If urgent sample is required and non-invasive technique not practical then surprapubic aspiration
Catheter can also be used but only fresh sample can be used for sampling for infection
What are you looking for in urine dip?
Leucocytes
Protein
Nitrites
How do we definitively diagnose UTI in children?
Confirmation of diagnosis requires culture of a pure growth of a single pathogen of at least 10^4 colony-forming units per litre of urine.
In children less than 3 years old urgent microscopy should be used to diagnose UTI.
Which children diagnosed with a UTI should be admitted?
All infants under 3 months should have urgent paediatrician referral
All children with an upper UTI should be considered for admission
How do we manage a child of more than 3 months who is found to have a lower UTI with no signs of pyelonephritis?
3 day course of oral antibiotics - trimethoprim, nitrofurantoin, cephalosporin or amoxicillin.
Safety net parents and tell them to come back if child still unwell in 24-48 hours
How do we manage a child of less than 3 months who is found to have a UTI?
Admit and refer to paediatrics
Parenteral antibiotics
How do we manage a child of more than 3 months who is found to have a UTI with signs of upper urinary tract involvement?
Consider admission
IV antibiotics (if admitted) for 2-4 days
Oral antibiotics (if not admitted) for 7-10 days: cephalosporin or co-amoxiclav
Which children should be investigated further having been treated for a UTI?
Recurrent episodes:
2 or more episodes with upper urinary tract signs
1 upper UTI and at least 1 lower UTI
More than 3 lower UTIs
Presence of any atypical features: Non E. coli UTI Failure to respond to treatment within 48 hours Sepsis Abnormal renal function
What further investigations might be for a child post-UTI treatment?
USS - renal abnormalities
Micturating cystourethrogram (MCUG) - reflux
Static radioisotope scan (DMSA) - renal function/scarring
Who should receive an urgent ultrasound during acute UTI?
Those under 6 months who have recurrent UTIs
All children found to have atypical UTI (Non E. coli UTI, failure to respond to treatment within 48 hours, sepsis, abnormal renal function)
Who should have an ultrasound done in the 6 weeks following treatment of UTI?
Those under 6 months who responded well to treatment but do not have recurrent or atypical features (these groups will need more urgent USS)
Those older than 6 months with recurrent UTIs
Who should have a static radioisotope scan to detect renal function and scarring 4-6 months following treatment of UTI?
Those under 3 years who have had atypical or recurrent UTIs
Those older than 3 years who have had recurrent UTIs
Who should have a micturating cystourethrogram to assess diagnosis of reflux following treatment of a UTI?
Those under 6 months who have atypical or recurrent UTIs.
