UTI

Question 1

Definition of UTI

Answer 1

Bacterial growth with symptoms
Asymptomatic uti 1-2% of kids
Antibiotics no help and increase resistance

Question 2

Boys get uti more than girls as neonates

Answer 2

True
Boys pick as neonates 
Girls peak 6-12/12 girls 8% get a UTI in childhood 2x that of boys 
Boys proteas
Girls E. coli

Question 3

UTI cause SBI in children

Answer 3

True <5 years 3-4 %
<12/12 7%
Recurrence rate of uti 12-14%
In younger children often non specific poorly localized presentation
Irritable/fever/ vomiting/ jaundice/ poor feeding/GI upset
Older children dysuia /fever/ abdo pain/haematuria/ loin pain

Question 4

Bag urine is for screening not for MCS

Answer 4

Suprapubic urine any growth = UTI
In /out catherter >107
Fresh void 108
Single organism

Question 5

Nitrates + assume UTI and treat as such

Answer 5

True

Question 6

Pylonephritis

Answer 6

Oral /IV antibiotic 7-10 nice and 7-14 days

UTI /cystitis treat 2-4 days as effective as 7 days

Question 7

Infants <3/12 fever

Answer 7

Septic work up
Admit
IV antibiotics

Question 8

When would you use IV antibiotics in a septic kid with ? UTI

Answer 8

Unwell
Can’t tolerate oral antibiotics
Known structural abnormality
Treat IV until fever gone

Question 9

UTI

Answer 9

Oral cehalexin
Iv in neonate ampicillin and gentamicin
Older child gentamicin alone

Question 10

What investigations post uti treatment

Answer 10

USS first line its safe
Mag 3 most commonly done 2nd line screening test
DMSA structure of the kidney and the scarring
MCUG gold standard for reflux /valves

Question 11

MCUG

Answer 11

Gold standard for reflux and valves
Do in children with recurrent PN
Give prophlaxisis antibiotics for MCUG
Don’t do in a sick febrile child 
Do >5year old child

Question 12

USS of kidneys

Answer 12

First line test in UTI 
Safe 
Do if child <3/12 of age 
Acutely unwell
Recurrent UTI
Unusually MO eg staph or pseudomonas 
Lack of clinical response in 48hours
Abdo mass
Poor stream dribbling in males

Question 13

Recurrent UTI and prophylactic antibiotics

Answer 13

Prophlaxisis NNT =12 decreases the chance of recurrence by 8%
But 2x increased risk of resistance

Question 14

Circumsciosion

Answer 14

Reduces the risk of recurrent UTI

Question 15

Reflux and UTI

Answer 15

Avoid surgery if possible more medical treatment if possible

Question 16

Recurrent UTI with a normal renal tract

Answer 16

Good fluid intake 
Regular voiding 
Avoid and treat constipation 
Avoid local irritable 
Promote good bladder voiding

Question 17

Vertical ureteric reflux causes ESRD

Answer 17

VUR is common 1-5% of all kids BUT RARELY cuases ESRD