URINARY TRACT INFECTIONS

Question 1

In the first 3 months of life, are boys or girls more likely to develop an UTI?

Answer 1

Boys

Question 2

Between the ages of 3 and 12 months, are boys or girls more likely to develop an UTI?

Answer 2

Equal

Question 3

After the first year of life, are boys or girls more likely to develop an UTI?

Answer 3

Girls

Question 4

What percentage of girls will have a UTI in childhood?

Answer 4

Up to 8%

Question 5

What percentage of boys will have a UTI in childhood?

Answer 5

Up to 2%

Question 6

What are the clinical features of UTI in infancy?

Answer 6

Poor feeding

Vomiting and diarrhoea

Irritability

Failure to thrive

(Jaundice in very young and neonates)

Question 7

What are the clinical features of UTI in younger children (1-5 years)?

Answer 7

Abdominal pain

Dysuria

Fever

Malaise

Nocturnal enuresis

Question 8

What are the clinical features of UTI in older children (older than 5 years)?

Answer 8

Dysuria

Frequency

Haematuria

Fever

Loin pain

Question 9

What is the organism most commonly responsible for UTI in children?

Answer 9

E. coli originating from bowel flora

Question 10

Apart from E. coli, what are the organisms commonly responsible for UTI in children?

Answer 10

Proteus - especially in boys

Klebsiella

Pseudomonas

Enterococcus sp

Question 11

What is the most common factor predisposing a child to UTI?

Answer 11

Urinary stasis

Question 12

What are the important causes of urinary stasis in a child which might therefore predispose them to having a UTI?

Answer 12

Vesicoureteric reflux

Obstructive uropathy eg ureterocoele, urethral valves

Neuropathic bladder eg spina bifida

Habitual infrequent voiding and constipation

Question 13

What are the NICE guidelines surrounding which children should have a urine sample checked?

Answer 13

Signs and symptoms of UTI

Unexplained fever of 38˚C or higher

Alternate site of infection but who remain unwell despite treatment

Question 14

What is the are the different methods of collective urine samples for lab tests and which is the prefered method?

Answer 14

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

Question 15

What are you looking for in urine dip?

Answer 15

Leucocytes

Protein

Nitrites

Question 16

How do we definitively diagnose UTI in children?

Answer 16

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.

Question 17

Which children diagnosed with a UTI should be admitted?

Answer 17

All infants under 3 months should have urgent paediatrician referral

All children with an upper UTI should be considered for admission

Question 18

How do we manage a child of more than 3 months who is found to have a lower UTI with no signs of pyelonephritis?

Answer 18

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

Question 19

How do we manage a child of less than 3 months who is found to have a UTI?

Answer 19

Admit and refer to paediatrics

Parenteral antibiotics

Question 20

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?

Answer 20

Consider admission

IV antibiotics (if admitted) for 2-4 days

Oral antibiotics (if not admitted) for 7-10 days: cephalosporin or co-amoxiclav

Question 21

Which children should be investigated further having been treated for a UTI?

Answer 21

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

Question 22

What further investigations might be for a child post-UTI treatment?

Answer 22

USS - renal abnormalities

Micturating cystourethrogram (MCUG) - reflux

Static radioisotope scan (DMSA) - renal function/scarring

Question 23

Who should receive an urgent ultrasound during acute UTI?

Answer 23

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)

Question 24

Who should have an ultrasound done in the 6 weeks following treatment of UTI?

Answer 24

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

Question 25

Who should have a static radioisotope scan to detect renal function and scarring 4-6 months following treatment of UTI?

Answer 25

Those under 3 years who have had atypical or recurrent UTIs

Those older than 3 years who have had recurrent UTIs

Question 26

Who should have a micturating cystourethrogram to assess diagnosis of reflux following treatment of a UTI?

Answer 26

Those under 6 months who have atypical or recurrent UTIs.