UTI Flashcards
Epidemiology of UTIs?
- Occurs in 5% of infants and young children with fever and no apparent source
- Highest risk in uncircumcised boys < 3 mo and girls <12 mo
Note: Most common bacterial infection in children < 2 years old
Untreated UTIs can lead to?
renal scarring
Overdiagnosis of UTIs can lead to?
- misuse of antibiotics
- unnecessary imaging
Signs and symptoms of UTIs?
- fever
- abdominal pain
- vomiting
- diarrhea
- new onset of urinary incontinence
- strong-smelling urine
Contributing factors in incomplete bladder emptying?
1, infrequent voiding - bladder enlargement
2. vulvitis
3. incomplete micturition with residual postmicturition bladder volumes
4. obstruction by a loaded rectum in constipation
5. neuropathic bladder
6. vesicoureteric reflux
Important question to ask in family history?
Ask about history of vesicoureteral reflux in parents and siblings
Clinical features in infants?
- fever
- vomiting
- lethargy/irritability
- poor feeding/faltering growth
- jaundice
- septicemia
- offensive urine
- febrile seizures (>6 months)
Clinical features of UTI in children?
- dysuria, frequency, urgency
- abdominal pain/loin tenderness
- fever
- lethargy and anorexia
- vomiting, diarrhea
- haematuria
- offensive/cloudy urine
- febrile seizure
- recurrence of enuresis
Methods of dipstick testing?
- nitrite stick testing
- leukocyte esterase stick testing (WBC)
Interpretation of nitrite stick testing?
+ result is likely indicative of a true UTI
- but some children with UTI may be nitrite -
Interpretation of leucocyte esterase stick testing?
- may be present in child with UTI
- may also not be present - present in febrile illness without UTI
- in balanitis and vulvovaginitis
Diagnostic criteria of UTIs?
- urinalyis shows pyuria and/or bacteriuria
- urine culture grows >50,000 CFU/ml of bacteria
Note: obtain urine specimen before giving antibiotics
3 ways to obtain urine culture?
- Suprapubic aspiration
- Invasive, requires expertise, painful
- May be necessary in boys with phimosis and girls with labial adhesions - Catheterization
- Invasive
- High sensitivity (95%), specificity (99%) - Bag applied to perineum
- False positive result 88-99% of the time!
Risk factors for UTIs in girls?
- white race
- temp. >39 degrees
- fever lasting >2days
- no other source of infection
- age<12 months
Risk factors for UTI in boys?
- non black race
- temp. >39 degrees
- fever lasting >24 hours
- no other source of infection