Gremlin: UTI

Question 1

UTI risk factors

Answer 1

• female
• if male, uncircumcised
• neonate and infants
• constipation
• anatomic abnormalities (VUR)
• functional abnormalties (neurogenic bladder)
• female sexual activity
• immunocompromised
• DM
• genetic predisposition

Question 2

cystitis

Answer 2

lower UTI, bladder

Question 3

urethritis

Answer 3

lower UTI, urethra

Question 4

pyelonephritis

Answer 4

upper UTI, kidney

Question 5

complicated vs. uncomplicated UTI

Answer 5

• complicated: GU tract with structural or functional abnomrlaites; catheters
• uncomplicated: anatomically normal UT and no prior instrumentation

Question 6

UTI s/s in neonates

Answer 6

• Janudice
• Failure to thrive: specifically failure to gain weight
• Fever
• Diffculty feeding
• Vomitting
• Diarrhea

nonspecific, consistent wiht infectious diseases in general

Question 7

UTI s/s in infants and children < 2 yrs

Answer 7

• Failure to thrive: specifically failure to gain weight
• Fever
• Diffculty feeding
• Vomitting
• Diarrhea
• Cloudy or malodorous urine
• Hematuria
• Increased urinary frequency
• Dysuria

Question 8

UTI s/s in children > 2 yrs

Answer 8

• Fever
• Icreased urinary frequency
• Dysuria
• Enuresis (in a previously toilet-trained child)
• Hematuria
• Abdominal pain

Question 9

UTI dx

Answer 9

• gold standard: suprapubic urine culture: any growth = UTI
  - not commonly performed, more commonly, clean catch method is used, though it is mroe unreliable: need >100,000cfu/ml of one bacteria for UTI
  - catheterization: need >50,000cfu/ml of one bacteria for UTI
  - rapid urine test do NOT replace urine cultures

Question 10

UTI first line treatment

Answer 10

• Cephalosporins (NOT 3rd gen if neonate, esp ceftraixone)
• Bactrim (NOT for pts under 2 months)
• Betalactam (includes augmentin)

Question 11

UTI treatment: paretneral or IV vs PO

Answer 11

PARENTERAL

• Use in acutely ill (septic) children, infants <2 months, immunocompromised, unable to tolerate PO
• Continue until pt is afebrile adn clincally stable then transition to PO

PO

• Complete course in pt iniated on parenteral abx
• Intial treatment in children who did not qualify for parenteral

Question 12

UTI treatment duration

Answer 12

• Uncomplicated UTI: 7 days
• Pyeloneprhtis: 14 days

Question 13

main goal of UTI ppx

Answer 13

prevent renal scarring

some UTI ppx controversy: there was a study done adn ppx for sure reduced incidence of UTI, but it did not reduce rate renal scarring compared to placebo - plz consider antimicrobial resistance

Question 14

candidates for UTI ppx

Answer 14

• Urianry tract abnormalities
• Pts with VUR grade IV or V
• Recurrent UTIs

Question 15

duration of UTI ppx

Answer 15

until resolution of underlying predisoposing conditoins or 1-2 years

Question 16

UTI ppx agents and their doses

Answer 16

• Keflex 12-15 mg/kg PO QD
• Amoxicillin: 10-15 mg/kg PO QD
  
  • Preferred in pts < 2 months
• Nitrofurantoin 1-2mg/kg PO QD
• Bactrim
  
  • 2mg/kg po QD
  • 5mg/kg PO twice weekly

generally avoid keflex for ppx because it is the firstline treatment, don’t want resistance

Question 17

nitrofurantoin ADR

Answer 17

urine discoloration

Question 18

bactrim ADR

Answer 18

• hematologic AE
• intersitial nephritis

Question 19

risk factors for developing or havuing VUR

Answer 19

• febrile UTI
• family hx
• prenatal hydronephrosis

Question 20

VUR

Answer 20

vesicouretal reflux; retrograde urinary flow from bladder to ureters

Question 21

VUR treatment

Answer 21

Pts tend to have sponatenous resolution for less severe cases; surgery can be considered in pts with severe
- uti ppx abx when appropraite