UTI

Question 1

Etiology

Answer 1

+/- 90% of uncomplicated first UTIs are caused by E coli
abnormal urogenital tract - Klebsiella, Proteus, Pseudomonas
- CAKUT
- recurrent UTI
- hospital acquired UTI
- treatment AB last 30 days

Question 2

Diagnosis

Answer 2

Dipstick test - leukocyte esterase and nitrite +
microscopy and culture
catheter or SPA (acutely ill infants) - not toilet trained
older continent children - mid stream clean catch urine collection

Question 3

How confirm diagnosis NB

Answer 3

urinalysis showing pyuria and/or bacteriuria
confirmation by culture
of a SINGLE uro-pathogen
- any culture from SPA sample or
- >/= 50 000 col/ml from catheter sample
urine analysis cannot substitute for urine culture
urine analysis helps to differentiate between aSx bacteriuria and UTI

Question 4

Treatment

Answer 4

prompt AB treatment - diminish risk renal scarring
start after appropriate urine specimen for MCS obtained
well appearing > 3 months - old can treated oral/IV AB
no sign difference in persistent kidney damage at 6-12months or in fever duration between
- oral 10-14 days vs
- IV 3 days followed oral for 10 days

Question 5

First line empiric treatment

Answer 5

oral - amoxicillin-clavulanic acid/2nd generation cephalosporin
parenteral
- amoxicillin-clavulanic acid +/- aminoglycoside
- ampicillin + aminoglycoside for suspected enterococcus
- piperaciilin + tazobactam
minimum 7 days optimal 7-14 days
DONT USE THIRD GEN CEPHALOSPORIN unless meningitis
NOT GIVE prophylactic AB - resistance
change AB according to sensitivity of organism
use correct dosage
once infant is afebrile and improving - switch to oral AB if possible
treatment
follow up culture is mandatory

Question 6

Investigations

Answer 6

Renal and Bladder ultrasound 
investigate for 
- atypical UTI 
- infants < 6m or 
- older children with recurrent UTI 
MCUG - micturating cystourethrogram - PUV 
MAG3 venogram - obstruction

Question 7

Strong predictors of UTI in neonates and infants

Answer 7

Fever > 38.5 
Female baby girl wearing nappy 
Uncircumcised male 
Persistence of fever > 24 hours 
Absence of another cause for fever

Question 8

Symptoms and signs in infants and toddlers

Answer 8

Abdominal pain 
Enuresis or urinary retention 
Irritability 
Unexplained or prolonged fever 
Poor appetite or poor growth

Question 9

Symptoms and signs in children > 6 years

more specific

Answer 9

Fever and rigors + frequency 
Enuresis 
Dysuria and urgency 
Headache 
Anorexia

Question 10

Symptoms and signs with an abnormal UT

Answer 10

Hypertension 
Urinary incontinence 
Dehydration and metabolic acidosis 
Poor weight gain 
Palpable kidney and bladder 
Poor urinary stream