UTI

Question 1

What is the most common organism that causes UTI?

Answer 1

E.coli

Question 2

What are the most common symptoms in a child <3/12?

Answer 2

1. Fever
2. Irritability/not-self/lethargic
3. Poor feeding
4. Vomiting

Question 3

What are the other possible Sx of UTI in any child?

Answer 3

Abdominal pain/loin tenderness
Dysuria
Rigors
Haematuria
Offensive/cloudy urine
Change in continence
Febrile convulsion
D&V
Jaundice

Question 4

What investigations should be carried out?

Answer 4

Urine dipstick

Urine culture - MC&S

Question 5

What on a dipstick would we be interested in in a UTI?

Answer 5

Nitrites and leukocytes

Question 6

When would you regard a dipstick to be a UTI

Answer 6

+ve for N&L - regard as UTI
+ve for N OR L, start antibiotics if there is clinical evidence of UTI, Dx on culture
-ve for N&L - unlikely UTI

Question 7

How should a child <3/12 with ?UTI be managed?

Answer 7

Immediate referral to hospital paediatric department

Question 8

What are the organisms of atypical UTI?

Answer 8

Non-E-coli organisms - usually klebsiella, pseudomonas or strep faecalis

Question 9

When is a UTI considered ‘atypical’?

Answer 9

1. Seriously ill/septicemia
2. Poor urine flow
3. Abdominal/bladder mass
4. Raised creatinine
5. Failure to respond to Abx within 48 hours
6. Infection with non-E-coli organsims

Question 10

When is UTI considered ‘recurrent’?

Answer 10

1. 2 or more episode of upper tract UTI
2. 1 episode of upper tract UTI + 1 episode of lower tract UTI
3. 3 or more episodes of lower tract UTI

Question 11

How is a child older than 3/12 with lower UTI treated?

Answer 11

3 day oral antibiotics as per local guideline, usually trimethoprim, nitrofurantoin, cephalosporins or amoxicillin. Advise to return if no resolution within 24-48 hours

Question 12

How is a child older than 3/12 with upper UTI treated?

Answer 12

Usually trimethoprim for 7 days orally, or

IV for 2-4 days (e.g. co-amoxiclav) followed by oral antibiotics for a total duration of 10 days

Question 13

What are the conservative measures for preventing recurrent UTI?

Answer 13

1. Dysfunctional elimination/constipation must be addressed
2. Encourage the child to drink
3. Don’t expect the child to delay voiding, ensure toilet readily available
4. Regularly voiding, and completely voiding when they do so (i.e. get them to go 1-2 mins later)
5. Good perineal hygeine