UTI Flashcards
Common pathogens
E.coli
Proteus
Pseudomonas
Kiebsiella
S+S:
<2 yrs old
2-5 yrs old
> 5 yrs old
Upper UTI
Dysuria Fever Lethargy Irritability Neonatal jaundice
Diarrhoea and vomiting
Reduced feeding
Failure to thrive
Colic
Similar to adults plus bed wetting
Bacteriuria plus fever >38 degrees or loin pain
Risk factors
Infrequent voiding and low fluid intake Urinary obstruction - usually from constipation in kids Vesuco-ureteric reflux of FH of it Previous UTI Not being circumcised
Urinalysis
Indications
Sample collection methods
Sample tests
UTI symptoms
Abdo pain
Fever with unknown cause
Pads When nappy is removed in boys Collection from sterile potty Suprapubic aspiration or catherterisation if severely ill or urgent Normal MSU if older
Ward-based microscopy
Dipstick for leukocytes and nitrates
Culture and sensitivity
Urinary Tract Imaging
3 ways to image:
1st line - USS - what is looked for and when?
2nd line - MCUG - what does it stand for? what does it look for and when?
3rd line - DMSA - what does it stand for? what does it look for and when?
Checks for abnormal anatomy or obstruction - Acutely or within 6 wks
Micturating cystourethrogram - checks VUR (Vesicoureteral reflux) - 3-6 months later
Dimercaptonsuccinic acid (DMSA) scintigraphy scan Checks for scarring - 3-6 months later
Image recommendations from NICE
1st time UTI <6 months of age
1st time UTI >6 months of age
USS within 6 weeks
Follow up MCUG if USS abnormal
No imaging needed
Image recommendations from NICE
What is an atypical UTI?
What is classed as a recurrent UTI?
What imaging is recommended for these 2 scenarios by NICE? USS, DMSA & MCUG
Newcastle guidelines? USS, DMSA & MCUG
No Rx response in 48 hours, seriously ill, non E.coli, abdo/renal mass, poor urine flow or increased creatinine
3 lower UTI’s /2 upper UTI’s
Acute USS
DMSA for all
MCUG if < 6 months
USS and DMSA for all including first UTI’s
DMSA not used if 5-12 yrs old, treated quickly and no RF’s
MCUG 4 wks later for all UTI’s under 1 yrs old
Management
When should antibiotics be given with culture and sensitivity?
NICE recommendation for no Rx and if child has UTI under 3 months old
If microscopy or dipstick is positive for infection / STRONG clinical suspicion
If both leuko and nitrates are negative and over 3 yrs old
Refer to paediatrics
Management
Antibiotics NICE recommends if lower UTI:
Name
How long
Route
Antibiotics NICE recommends if upper UTI:
Name
How long
Route
Newcastle guidelines
Trimethoprim
3 days
PO
Co-amoxiclav or cephalosporin
7-10 days
PO
Trimethoprim or cephalexin
7 days
PO
FOR ALL
Management
What if under 3 months old or severely ill? - 2 meds
Prophylaxis:
When to consider according to NICE?
When to consider according to Newcastle guidelines?
What is given? Name, route?
When to stop?
Advice that could be given to parents?
Amoxicillin + Gentamicin IV
Consider if recurrent
Under 1 yr old
Clinical judgement if 1-5 yrs old
Trimmethoprim PO daily
No UTI for a yr
Drinking and frequent voiding
Treat and prevent constipation
Clean perineum from front to back
Avoid bubble baths and nylon underwear
Complications
What about VUR?
Chronic pyelonephritis - scarring - kidney failure and/or HTN so check BP annually if there is scarring
Stones
Usually resolves
