UTI in Children Flashcards
What is bacteriuria ?
Bacteriuria – bacteria in the urine uncontaminated by urethral flora usually with no symptoms but can lead to renal scarring, raised BP and chronic renal disease.
What is a UTI?
UTI – symptomatic bacteriuria that may involve genitourinary sites
What is chronic pylonephritis?
Chronic pyelonephritis – radiological/histological diagnosis, renal scarring and dilated calyx
What are the risk factors for UTI in children?
Female after 3 months (males prior to this due to increased congenital abnormalities)
Previous UTI
GU abnormalities
How does UTI present differently at different ages?
Presentation by age
Infants: poor feeding, vomiting and irritability
Young kids: abdominal pain, fever, secondary enuresis and dysuria
Older kids: dysuria, frequency and haematuria
Non-specifically ill Collapse and sepsis Vomiting Failure to thrive Colic Dysuria Loin/suprapubic tenderness and fever suggest upper UTI
What are the most common causes for UTI in children (not asking about organisms)
Most have normal urinary tract
35% have vesico-ureteric reflux
14% have renal scars
5% have stones
How should a suspected UTI be investigated?
Urinalysis Us and Es FBC and CRP Micturating cystogram gold standard for reflux US looking for abnormalities and reflux
What are the indications for an USS in children with a UTI?
Indications:
• All children with UTI younger than 6 months
• In children 6 months to 3 years only if: systemically ill, poor urine flow, abdominal or bladder mass, raised serum creatinine, failure to respond to Abx within 48 hours and infection with non-E. Coli organisms.
• Recurrent UTIs – greater than or equal to 2 upper UTI, 1 upper plus 1 or more lower UTI or 3 or more lower UTI
How are UTIs managed in children of different ages?
If < 3 months – admit, IV amoxicillin and gentamicin or IV cephalosporin and ampicillin
If > 3 months with upper UTI – consider admit and 7-10-day course of trimethoprim, nitrofurantoin or amoxicillin/co-amoxiclav
If > 3 months and lower UTI then 3 day course of antibiotics (usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin). Return if still unwell after 48 hours
Adultescents – treat with oral antibiotics for 3-5 days according to adult guidelines
Generally upper UTI given antibiotics for 7-14 days – IV for 2-4 and oral for 10.
Lower UTI standard 3 day course.
Renal scarring can occur in one instance of reflux so treat any suspected UTI immediately even if that means treating it blind.
How should you treat a child with a UTI blind if they are septic with pyelonephritis?
If child very ill (septic and pyelonephritis) then treat blind with gentamicin
When should antibiotic prophylaxis be considered in recurrent UTIs?
Consider antibiotic prophylaxis after 2nd episode of UTI
What general advice can be given to prevent UTIs in future?
Treat any constipation and educate to wipe front to back
Plenty of fluids and encourage voiding
Empty bladder completely
No bubble baths and appropriate clothing choices
What is vesicoureteric reflux?
Abnormal backflow of urine from the bladder into ureters and kidneys. Common in children and predisposes to UTI.
What causes vesicoureteric reflux?
Ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle therefore shortened intramural course of ureter. Vesicoureteric junction cannot function adequately leading to reflux.
How are vesicoureteric refluxes graded?
- Incomplete filling of upper urinary tract and no dilation
- Complete filling of upper urinary tract and slight dilation
- Ballooned calyces
- Megaureter
- Megaureter and hydronephrosis
