UTI

Question 1

Pathogens and predisposing features

Answer 1

E. coli
Also Proteus (boys), Klebsiella, Pseudomonas and Enterococcus
Urinary stasis. May be due to: Vesicoureteric reflux; obstructive uropathy; neuropathic bladder (eg spina bifida); habitual infrequent voiding and constipation

Question 2

Clinical features

Answer 2

Predominantly boys up to three months, equal 3-12 months, girls thereafter
Neonates: jaundice, septicaemia rapidly => shock
Infants: non-specific; vomiting, diarrhoea, irritability, failure to thrive
1-5 years: fever, malaise, abdominal discomfort, frequency, nocturnal enuresis
>5: classic cystitis (frequency, dysuria, fever, enuresis) or pyelonephritis (fever, loin pain)

Question 3

Diagnosis

Answer 3

Culture of pure growth of single pathogen

3 - dipstick, but false negs if urine in bladder <1hour

Question 4

Collecting urine samples

Answer 4

1. Clean catch
2. Bag or pad sample
3. Suprapubic aspirate (if urgent)
4. Catheter, but only fresh samples valid

Question 5

Management

Answer 5

High risk of serious illness: urgent referral, plus all the ABC/sepsis stuff
3months, lower UTI: oral abx 3 days
>3months, upper UTI: oral abx 7-10 days