UTI

Question 1

How common is UTI in children and what are the common causative organisms?

Answer 1

3-7% of girls before the age of 6
1-2% of boys before the age of 6

Usually caused by bowel flora most commonly E.coli

Question 2

In a child presenting with haematuria what conditions would be on our differential diagnosis?

Answer 2

UTI most common cause but would have other features also.

HSP
Nephritic syndrome (IgA nephropathy)
Renal malignancy
SLE (more common in afro-carribeans and asians)

Question 3

What are the common presenting features in infants and older children?

Answer 3

Infants: (non specific)
Fever
Vomiting 
Lethargy 
Irritability

Children:
Fever 
Dysuria
Frequency
Loin pain if infection has ascended

Haematuria can occur however it is not very common

Question 4

What are the different methods of obtaining a urine sample?

Answer 4

Mid treat urine catch (preferred)

Catheter collecting the sample in to a bottle can be done if unable to obtain urine sample.

US guided suprapubic aspirate can be used in severely ill children however cather samples are largely replacing this method.

Question 5

What are the diagnostic criteria for a UTI from a urine dipstick and culture?

Answer 5

Urine dipstick:
Nitrites and leukocytes are suggestive of a UTI.
Nitrites more so, if positive nitrites start empirical antibiotic treatment.

Urine culture:
A bacterial culture of greater than 100,000 organisms per millilitre is strongly suggestive of UTI.

If there are mixed organism growths suggests potential contamination.

Question 6

Define an atypical UTI?

Answer 6

Atypical UTI
• Severe illness/septicaemia
• Failure to respond to suitable antibiotics within 48 hours
• Poor urine flow
• Abdominal or bladder mass
• Raised creatinine
• Infected with non-E.coli organisms

Question 7

Define a recurrent UTI?

Answer 7

One simple UTI + one Upper UTI

3 or more simple UTI’s

Question 8

Define cystitis and pyelonephritis?

Answer 8

Cystitis: inflammation of the bladder (simple UTI)

Pyelonephritis: infection of the upper UTI causing inflammation in the kidneys (usually a severe infection, high temp and rigours)

Question 9

What are the NICE guideline investigations for recurrent and atypical UTI’s in those younger than 6 months?

Answer 9

For both atypical and recurrent:

• Ultrasound during acute infection.
• DMSA (a radionucleotide scan to assess renal function) 4-6 months following acute infection
• MCUG (micturating cystourethrogram) 4-6 months after infection

Question 10

What are the NICE guideline investigations for recurrent and atypical UTI’s in those 6 months - 3 years?

Answer 10

Atypical – ultrasound during acute infection and DMSA 4-6 months following acute infection

Recurrent – ultrasound within 6 weeks and DMSA 4-6 months

Question 11

What are the NICE guideline investigations for recurrent and atypical UTI’s older than 3 years?

Answer 11

Atypical – ultrasound during acute infection

Recurrent – ultrasound within 6 weeks and DMSA 4-6 months

Question 12

Describe the treatment of a simple UTI (cystitis)?

Answer 12

3 months or older:
Treat with oral antibiotics for 3 days i.e. trimethoprim, nitrofurantoin.

If no improvement after 24-48hrs needs reviewing.

Question 13

Describe the treatment of pyelonephritis?

Answer 13

Consider specialist referral.

Depending on severity:
IV abx for 2-4 days followed by oral for a total of 10 days.

OR

Oral abx for 10 days.

Antibiotics with low resistance patterns should be used therefore follow local guideline e.g co-amoxiclav