UTI

Question 1

What are causative organisms of UTI?

Answer 1

E. coli
Proteus
PSeudomonas

Question 2

What are predisposing factors to UTI?

Answer 2

Incomplete bladder emptying

• infrequent voiding
• hurried micturition
• obstruction by full rectum due to constipation
• neuropathic bladder

Vesicoureteric reflux
- developmental anomaly found in 35% of children with UTI

Poor hygeine
- e.g. not wiping front to back in girls

Question 3

What are clinical features of UTI in infants, younger children, older children?

Answer 3

Infants:

• Poor feeding
• Vomiting
• Irritability

Younger children:

• Abdo pain
• Fever
• Dysuria

Older children:

• Dysuria
• Frequency
• Haematuria

Question 4

What features suggest an upper UTI?

Answer 4

Temperature > 38c

Loin pain/tenderness

Question 5

When should urine be checked in a child?

Answer 5

Any symptoms or signs suggestive of a UTI
Unexplained fever of 38 or higher
Alternative site of infection but who remain well

Question 6

What is bacteruria? Covert?

Answer 6

Bacteria in urine uncominated by urethral flora

Covert - no symptoms can lead to renal scarring, hypertension

Question 7

What urine collection method in children?

Answer 7

Clean catch is preferable - sample into waiting clean pot when nappy is removed - midstream urine sample to avoid urethral flora

If not possible - urine collection pads

Supra-pubic aspiration if not possible to collect urine

Question 8

What tests in UTI in children?

Answer 8

MC&S of clean catch urine sample
Urine dipstick:
- leucocyte and nitrites positive

US
- For detective reflux

In atypical/recurrent UTI in infants:
Consider DMSA scan and micturating urethrogram

Question 9

What information does a micturating urethrogram give?

Answer 9

Gold standard for investigating reflux

Question 10

What is DMSA scintigraphy for?

Answer 10

Gold standard for detecting renal parenchyma defect and scarring

Question 11

What management in children <3m with UTI??

Answer 11

Refer immediately to paediatrician

IV amoxicillin + gentamicin

Question 12

What management in children > 3m with uncomplicatedd lower UTI??

Answer 12

Oral antibiotics for 3 days:
Trimethoprim, nitrofurantoin, cephalosporins, amoxicillin
Use local guidelines and results of urine culture
Advise parent to return to GP if still unwell in 24-48 hours

Question 13

What advice for UTI management?

Answer 13

Avoid constipation
Increased oral fluids
Encourage full voiding

Question 14

What advice for UTI management?

Answer 14

Avoid constipation
Complete antibiotic course
Paracetamol for pain relief
Increased oral fluids
Encourage full voiding - access to clean toilets
Return if syptoms worsen

Question 15

What management in children > 3m with upper UTI?

Answer 15

Consider admission
Gentamicin
If not admitted: oral antibiotics for 7-10 days: cephalosporins or co-amoxiclav

Question 16

What are complications of UTI?

Answer 16

Renal scarring and damage
Hypertension
Renal insufficient and failure

Question 17

What prevention for UTI?

Answer 17

Consider prophylaxis if recurrent UTI, significant GU animal or renal damage

Trimethoprim prophylaxis

Avoid predisposing factors:
Treat and prevent constipation
Clean perineum front to back
Avoid nylon underwear and bubble baths
Encourage fluid intake
Double micturition