UTI in children and adolescents Flashcards
Urinalysis and urine culture
Criteria for diagnosis includes both a positive urinalysis (pyuria and/or bacteriuria) and urine culture (> 50,000 CFU/mL).
A clean-catch urine sample may be obtained if the child is toilet trained. If not trained, a straight catheterization is necessary.
Indicated in patients with suspected UTI that fulfill one of the following criteria:
1.Females and uncircumcised males of < 24 months of age with one of the following risk factors: either fever of unknown source or of duration > 24 hours, history of UTI, ill appearance, suprapubic tenderness, or nonblack race
- Circumcised boys < 24 months of age with at least two of the above risk factors
- Children older than 24 months with a suspected UTI based on urinary symptoms
- Any febrile infant or child with an abnormal urinary tract or family history of urinary tract disease
Renal and bladder ultrasound
(sotto i 24 mesi, una UTI confermata in urinocoltura richiede ecografia pelvica. Questo perchè ci può essere il rischio di alterazione anatomica delle vie urinarie)
Indicazioni
- Infants aged 2–24 months with a febrile UTI
- Children with either treatment failure, abnormal voiding, abdominal mass, recurrent UTI, or poor likelihood of follow-up
Voiding cystourethrography (VCUG) indicated in abnormal ultrasound (hydronephrosis, obstruction, scarring, or masses), abnormal voiding pattern, or recurrent UTI
Trattamento
- First-line: second- or third-generation cephalosporin (cefdinir, cefixime, cefpodoxime)
- Alternative: TMP-SMX, first-generation cephalosporin
Trattamento IV nei soggetti sotto i 6 mesi o sempre in uno stato settico o che non possono assumere liquidi per via orale. Al di sopra dei 6 mesi il trattamento è orale
Amoxicillina-acido clavulanico, Cefalosporina 3 generazione (no ceftriaxone)