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704 Pediatrics > Infections: UTI and AOM > Flashcards

Infections: UTI and AOM Flashcards

(46 cards)

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1
Q

What is the general flow of UTI likelihood in children?

A

Females > uncircumcised males > circumcised males

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2
Q

What presentation indicates a likely UTI?

A

Children <12 who present with fever

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3
Q

What is retrograde ascent?

A

Pathogens entering through the urethra and migrating to the bladder

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4
Q

What is nosocomial infection?

A

Introduction of foreign body to the UT (catheters for example) -> more resistant organisms

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5
Q

What are s/s of UTI in neonates?

A
  • Jaundice
  • Weight gain
  • Fever
  • Difficulty feeding
  • Vomiting/diarrhea
  • Irritability
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6
Q

What are s/s of UTI in children <2?

A

Similar to neonates
- Without jaundice
- Cloudy/malodorous urine
- Hematuria, frequency, dysuria

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7
Q

What are s/s of UTI in children >2?

A
  • Fever
  • Hematuria, frequency, dysuria
  • Abdominal pain
  • Enuresis (accidents)
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8
Q

T/F: Rapid urine tests may not be used to replace urine cultures for diagnosis.

A

TRUE

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9
Q

What is the gold standard for UTI diagnosis?

A

Suprapubic aspiration (SPA)

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10
Q

Since SPA is invasive and not commonly preferred, what other methods are commonly used for diagnosis?

A
  • Transurethral catheterization
  • Clean catch (unreliable)
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11
Q

What is diagnostic criteria for UTI?

A

Significant bacturia + pyuria
- Clean catch >100,000 cfu/mL of one bacteria
- Catheter: >50,000 cfu/mL of one bacteria
- SPA: any growth of bacteria

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12
Q

What is first line treatment for UTIs?

A

Cephalosporins
Bactrim
B-lactam/B-lactamase inhibitor

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13
Q

When is parenteral treatment required for UTI?

A
  • Sepsis
  • Infants <2 months
  • Immunocompromised
  • Unable to tolerate PO

-> continue until stable and afebrile

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14
Q

What is the treatment duration for uncomplicated UTI?

A

7 days

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15
Q

What is the treatment duration for pyelonephritis?

A

14 days

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16
Q

What is VUR?

A

Urinary backflow from bladder to ureters or kidneys (1% incidence)

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17
Q

What is the estimated prevalence of VUR in febrile children with UTI?

A

25-40%

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18
Q

What are risk factors for VUR?

A
  • Febrile UTI
  • Parent/sibling with VUR
  • Prenatal hydronephrosis
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19
Q

What are complications of VUR?

Study These Flashcards
A
  • Recurrent UTI
  • Renal scarring
  • HTN
20
Q

How can VUR be dealt with?

Study These Flashcards
A

Observation (typically resolves within 4-5 years)
Antibiotic prophylaxis
Surgery

21
Q

Who might be candidates for UTI prophylaxis?

Study These Flashcards
A
  • Neonates/infants evaluated for anatomic or functional UT abnormalities
  • Children with VUR
  • Children with dysfunctional voiding
  • Immunocompromised
  • Children with recurrent UTIs and normal anatomy/function
22
Q

Based on current evidence, who should be considered for UTI prophylaxis?

Study These Flashcards
A
  • Females
  • VUR grade IV/V
  • Bladder dysfunction
23
Q

How long should UTI prophylaxis last?

Study These Flashcards
A

1-2 years (“outgrown”) or until surgically repaired

24
Q

What UTI prophylaxis is preferred for neonates/infants <2 months?

25
What UTI prophylaxis is preferred for infants >2 months?
Bactrim or nitrofurantoin
26
What should we generally avoid for UTI prophylaxis (drug-wise)?
Cephalosporins (resistance)
27
What is uncomplicated AOM?
AOM without otorrhea
28
What is non-severe AOM?
AOM with the presence of mild otalgia AND temperature <39C
29
What is severe AOM?
AOM with the presence of moderate to severe otalgia OR fever >39C
30
What is recurrent AOM?
- 3 or more well-documented and separate AOM occasions in past 6 months OR - 4 or more episodes in the past 12 months with at least 1 in the past 6
31
What is the second most common pediatric diagnosis in the ED?
AOM
32
What is the peak age of incidence for AOM?
6-12 months
33
T/F: Males are at slightly higher risk for AOM and 80% of all children will have AOM at least once in life
TRUE
34
What are the 3 most common bacteria that cause AOM
- S. pneumoniae - H. influenzae - Moraxella catarrhalis
35
What are risk factors for AOM?
- Genetics/hereditary - Allergies - Lack of breastfeeding - Low socioeconomic status - Passive smoke exposure - Daycare attendance - Pacifier use - Winter season
36
What is the hallmark s/s for AOM?
Otalgia -> pulling/tugging ear
37
What is the diagnostic criteria for AOM?
- Moderate to severe bulging of TM OR - New onset of otorrhea that is not caused by otitis externa OR - Mild bulging of TM with recent ear pain or erythema
38
What is the treatment recommendation for children >2 years with mild AOM symptoms?
Watchful waiting
39
Besides mild AOM children >2 years, when else can watchful waiting be considered?
Patients 6 months - 2 years with UNILATERAL AOM and NO otorrhea
40
When should antibiotics be considered during AOM watchful waiting?
48-72 hours if symptoms are persistent or worsening
41
What is first-line treatment for AOM?
Amoxicillin 80-90 mg/kg/day in 2 divided doses OR Augmentin: 90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate
42
What alternative first line treatments can be given to AOM patients with a penicillin allergy?
Cefdinir 14 mg/kg/day in 1 or 2 divided doses OR Cefuroxime 30 mg/kg/day in BID OR Cefpodoxime 10 mg/kg/day in BID OR Ceftriaxone 50 mg IM or IV QD
43
How long should a child <2 be treated for AOM?
10 days of amoxicillin
44
How long should a child >2 be treated for AOM?
5-7 days possible
45
What analgesics can we consider for AOM
Ibuprofen 5-10 mg/kg/dose Q6H PRN (only 6+ months old) Acetaminophen 10-15 mg/kg/dose Q4-6H PRN
46
What procedure can be done for those with recurrent AOM?
Tympanostomy tubes

704 Pediatrics (6 decks)

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