Peds UTI Flashcards
(21 cards)
What are the host factors for UTI?
Age Lack of Circumcision Female Race Genetics Urinary obstruction Bladder/Bowel Dysfunction Vesicourethral reflux Sexual Activity Bladder Cath
What is the most common Bacterial Cause of UTI?
E. Coli
Also Klebsiella, Proteus, Enterobacter, Citrobacter (inc Risk of renal scarring)
What are the risk factors for Renal Scarring?
Recurrent febrile UTI Delay in Tx Bladder/Bowel Dys Obstruction VU reflux
What are predictors for Renal Scarring?
VU reflux Abn Renal bladder US Inflammatory markers Temp >39 Cause not E. Coli
What is the Clinical presentation of UTI in kids
Fever >40 deg or >24hr Suprapubic Tenderness Lack of circ Fever in absence of source Irritability, poor feeding
What is the presentation of UTI in older kids?
Abdominal/Back pain
Dysuria
New-onset incontinence
CVA/suprapubic tenderness
When should you get a urine sample from a peds patient?
Girls and Uncirc boys 2 w/ Urinary symptoms
Circ boys >2 w/mult urinary symptoms
How can you get a urine specimen from a child?
Not TT = Cath or suprapubic asp
TT = Clean voided specimen
Examine ASAP
Don’t use a bag
What tests do you do on Urine test?
Dipstick: Leuk Est and Nitrite
Micro: WBC >5/hpf =Pyuria
Any bacteria =pyuria
Culture if neg
What are the indications for hospitalization?
Age
WHat is the most comon cause of UTI in Preterm infants?
Coag negative Staph and Klebsiella
More hemo than ascending
WHat is the most comon cause of UTI in term infants?
E coli
Ascending more than hematogenous
What is the Tx of Pediatric UTI?
IV ampicillin + Gentamycin 10-14 days
3 gen Ceph and Aminoglycosides
+ Amoxicillin if suspect enteroC
What is Tx of UTI that fails to respond?
Add amoxicillin
Obtain Renal and Bladder US
Obtain Urine c/s
What is VUR?
Vesicourethral Reflux 1^ UV junction doesn't close Shortening of Ureter 2^ Abn high pressure in bladder Assoc w/ anatomic or functional bladder obs
What are the grades of VUReflux?
G1- only ureter
G2- ureter and collecting syst
G3- Mild dilation
G4- filling and gross dilation. tortuosity of ureter
G5- Sig ureteral dilationloss of papillary impression
What is the medical Tx for VUR?
Daily Abtx prophylaxis
Monitor via cystography
What is the surgical Tx for VUR?
Correct anatomy at refluxing UV junct
Surgical Reimplantation
Endoscopic correction
What is Voiding Cystourethrogram?
Test of choice of VUR
What is Bladder and Bowel Dysfunction?
Constipation, Daytime wetting, freq and urgency
Tx reduces occurrences
Timed voiding
Laxatives
What are the indications for referral in Ped UTI?
VUR Obstructive uropathy Renal Abnormalities HTN Impaired kidney function Refractory BBD
