UTI Flashcards
Vaccines and fever
major adverse effect to vaccines is fever that occurs within 24-48 hrs on first dose of particular inoculation
Fever without a source
Complete history has been obtained and detailed PE performed and no source of fever found
*most common = viral syndrome
Possible etiologies serious bacterial illness (SBI)
UTI Meningitis Sepsis PNA Bacterial gastroenteritis Osteomyelitis Septic arthritis Occult bacteremia
Occult bacteremia
Child with bacteremia that appears well –> generally does NOT develop into SBI
Strep pneumo, Hib, neisseria, salmonella
Meningitis in Infants
Kernig's or Brudzinski's signs, nuchal rigidity Fever, hypothermia Bulging fontanelles, lethargy Irritability, restlessness Paroxysmal crying, poor feeding Vomiting, diarrhea
WBC differential
Leukocytosis with a “left-shift” (immature neutrophils) indicates a bacterial infection rather than a viral infection
Oral vs IV antibiotics
Oral - UTIs can mostly be managed with oral meds
IV - if patient appears “toxic” or cannot retain oral medications
Role of prophylactic Abx in UTI kids
have been shown to be beneficial in reducing UTIs in kids with vesiculo-ureteral reflux
Kernig’s sign
resistance with extension of knee
Brudzinski’s sign
flexion of hip and knee in response to flexion of neck by examiner
DDx of infant with fever
UTI PNA Sepsis Bacterial/Viral meningitis Roseola Occult bacteremia Herpes simplex Otitis media Vaccine reaction
UTI
commonly presents as fever and no focus on PE, fussiness and lack of appetite
RISKS: uncircumcised male, female
PNA
most children with PNA have cough, tachypnea, fever, rales, low SaO2
consider CXR
Sepsis
systemic response to infectious agent - inflammation throughout body –> vasodilation and increased permeability
FEVER, looking toxic, tachycardia, poor perfusion, bacteremia
Bacterial Meningitis
S. pneumo or N. meningitidis Kernig's or Brudzinski's signs, nuchal rigidity Fever, hypothermia Bulging fontanelles, lethargy Irritability, restlessness Paroxysmal crying, poor feeding Vomiting, diarrhea
Viral Meningitis
symptoms typically less severe than bacterial
- enterovirus is most common
Roseola
common viral illness in kids under 2
- HHV-6
- high fever for 5 days followed by rash
Testing for fever without source
UA and urine culture - need a clean sample
CBC - left-shift = bacterial origin likely
Blood culture - if febrile and looks ill, it may be necessary
LP - unable to ID fever source, inconsolable, pale -> think about it
UA interpretation
Pyuria - >5 WBCs per field
Nitrie Test - happens with gram (-) –> reduces nitrate to nitrite (E.Coli and Klebsiella), positive test has high specificity
Leukocyte esterase - product of broken-down leukocytes
Follow-up from first pyelonephritis episode
US of kidneys and bladder - renal structure and dilation
Voiding Cystourethrogram - demonstrates presence of vesicoureteral reflux if present –> don’t do unless findings on US suggest it
Managing Occult Bacteremia
Empiric treatment not recommended
- close follow up and document everything
IV ABx treatment for pyelonephritis
- Ampicillin/Gentamicin - resistance rising so make sure to use gentamicin to get coverage against E. Coli
- Ceftriaxone - excellent coverage against gram (-), excellent safety for kids
- Piperacillin/tazobactam - good coverage against gram (-) and covers pseudomonas
Oral ABx treatment for pyelonephritis
- Keflex (1st gen) - inexpensive and well tolerated
- Sulfisoxazole - wide resistance, don’t use
- Nutrofurantoin - good [ ] only reached in urine, not blood
- Ciprofloxacin - expensive, possible adverse effect
- Augmentin - effective but skin and GI side effects
- Bactrim - effective but sulfa
