UTI

Question 1

What bugs cause UTIs in paeds?

Answer 1

E.coli = typical

Anything else is atypical e.g. klebsiella, enterococcus

Question 2

How does UTI present in paeds?

Answer 2

Systemic:
Fever
Vomiting - may be only sign sometimes 
Lethargy 
Irritability
Poor feeding
Not gaining weight properly
Jaundice in very young newborns 

Specific:
Dysuria
Frequency
Deliberate retention
Change in their normal toilet habits, such as wetting themselves or wetting the bed
Abdo or back pain
Unpleasant-smelling, bloody or cloudy urine

Question 3

What conditions are associated with UTI in paeds?

Answer 3

Constipation – this can sometimes cause part of the large intestine to swell, which can put pressure on the bladder and prevent it emptying normally

Dysfunctional elimination syndrome – a relatively common childhood condition where a child “holds on” to their pee, even though they have the urge to pee

Vesicoureteral reflux – an uncommon condition where urine leaks back up from the bladder into the ureters and kidneys; this occurs as a result of a problem with the valves in the ureters where they enter the bladder

Question 4

How do you investigate UTI in paeds?

Answer 4

Urine dip:
+ve for leukocytes, nitrites, poss blood, protein, glucose

Urine MC+S

Bloods:
U+E - for renal function (underlying kidney disease?)

USS renal tract:
Any structural abnormality?

Dimercaptosuccinic acid scintigraphy (DMSA) – to detect parenchymal defects within 4-6m following acute infection (RECURRENT UTI ONLY)

Question 5

How do you manage UTI in paeds?

Answer 5

Lower UTI/cystitis:
Trimethoprim – 4mg/kg BD for 3days 
OR
Nitrofurantoin – 750micrograms/kg QDS for 3days  - ONLY IF CHILD IS SYSTEMICALLY WELL AS ONLY REALLY TARGETS URINARY TRACT 
OR
Amoxicillin – 125mg TDS for 3days 

Upper UTI/acute pyelonephritis:
Cefalexin at 12.5mg/kg BD for 7-10 days
OR
Co-amoxiclav at 0.25ml/kg of 125/31 suspension TDS for 7-10 days