UTI Flashcards
Risk Factors for UTI
Female - Shorter urethra, wipe back to front
Constipation in sigmoid or rectum
Poor urine flow or dysfunctional voiding. (not going when they need to go)
Previous UTI
Fam hx of Vescioureteric reflux or renal disease
Neurogenic bladder: spina bifida or spinal lesions (cause stasis of urine)
Tx for UTI
Any child with pyleonephritis, start IV abx immediately. Co-amoxiclav + gentamicin.
If < 3 months add, cefatoxime
Give for 7-10 days
Always rescan the kidney after 4-6months to check for dilation or abnormalities.
When should you switch from IV to PO abx
- IV for at least 48 hours
- Child hasn’t had temperature for 24 hours
- Blood cultures are negative
- No renal abnormality
What is recurrent UTI
2 pyelonephritis (or) 1 pyelonephritis + 1 cystitis
Over 6 months
(or)
3 cystitis over 1 year.
Atypical UTI features
- Seriously ill, septicemia
- poor urine flow
- Abdo or bladder masses
- Failure to respond to abx w/in 48 hours - do US for abscess
- Infection with non-E Coli organisms (Proteus, Klebsiella, pseudomonas)
- Raised Creatinine
What is the gold standard for diagnosing vesicoureteric reflux? What added measures must be taken or explained to the patient?
MCUG - micturating cystourethrography
There is radiation exposure & requires prophylatic antibotics.
When are urine cultures sent?
- Any child < 3 months with fever
- +ve dipstick
- Recurrent UTI (can you recall the definition of recurrent UTI?)
- Not responding to treatment
Whats the most common organism causing UTI
E Coli
Which organism is more common in boys than girls? And what does it predispose them to?
Proteus. predisposes to renal phosphate stones
Which bacteria is more common in neonates
Grp B
If ptx has poor urinary flow, what organism is more likely to be present?
Pseudomonas
What imaging will you do for < 6mo old that is responding well to Tx?
Just a USS 6 weeks after infection to check for scarring
What imaging will you do for < 6mo old that has atypical UTI? (what constitutes as an atypical UTI?)
Acute USS during infection
DMSA 4-6 months after
MCUG - 6 months after infection
What is DMSA gold standard for?
Detecting Renal scarring
What imaging will you do for < 6mo old that has recurrent UTI?
Acute USS during infection
DMSA - 4-6 months after
MCUG - 6 months after infection
For children 6mo to 3 years, when do you not require imaging?
When they respond well to tx
For children 6mo to 3 years wth atypical UTI, what imaging do you want?
Acute renal USS during the infection
DMSA after 4 months for scarring
For children 6mo to 3 years wth recurrent UTI, what imaging do you want?
US 6 weeks after infection
DMSA after 4 months for scarring
For children > 3 years, when do you reqiure imaging? Which would you want?
If they aren’t responding to treatment or atypical UTI or recurrent UTI.
For atypical: need an acute renal USS. Thats it.
For recurrent UTI:
- US after 6 weeks post infection
- DMSA 4 months after for scarring
What is the incidence of VUR if there is a fam hx in a 1st degree relative?
30-50%
With growth, reflux resolves in what % of patients?
10%
What are the associated urinary tract abnormalities?
Posterior urethral valves
Bladder exstrophy (skin over bladder didn;t close, exposed to outside environment)
Ureterocoele (congenital, ureters balloon into bladder)
Ureter duplication
Describe the grades of VUR (just the 1st 4 grades). There is a 5th one
grade 1: reflux into upper part of ureter. no dilation
grade 2: reflux into ureter + collecting systems. No dilation
grade 3: Grade 2 + mild dilation. And mild blunting of calyces.
Grade 4: Grossing dilates the ureter & collecting system. More obvious blunting of calcyes
Describe 5th grade of VUR
Grade 5: Massive reflux, gross dilation. ALL calcyes are blunted. Loss of papillary impression. +/- intrarenal reflux
Significant ureteral dilation & torsion
