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Paediatrics finals > Urinary tract infections > Flashcards

Urinary tract infections Flashcards

1
Q

What are UTIs?

A

Infections of the urinary tract

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2
Q

At what age do UTIs occur?

A

Any age

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3
Q

What are UTIs caused by?

A

Micro-organisms in the urinary tract

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4
Q

Which microorganisms commonly cause UTIs?

A

E.coli (>85%)
Klebsiella species
Staphylococcus saprophyticus

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5
Q

List the 3 types of UTI

A

Upper
Lower
Undifferentiated

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6
Q

What do lower UTIs affect?

A

Urethra and bladder (cystitis)

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7
Q

What do upper UTIs affect?

A

Renal pelvis and kidneys (pyelonephritis)

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8
Q

What is an undifferentiated UTI?

A

When you are unable to distinguish between Upper and lower

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9
Q

List some risk factors for UTI in children

A 
Age <1yo 
Female (after >3months) 
Caucasian 
Previous UTI
Voiding dysfunction
Vesicoureteral reflux (VUR) 
Sexual abuse
Spinal abnormalities
Constipation
Immunosuppression
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10
Q

List the clinical features from the history of a UTI in infants <3months

A 
Vomiting
Fever
Lethargy 
Poor feeding
Failure to thrive
Abdo pain 
Jaundice
Haematuria
Offensive smelling urine 
Irritability
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11
Q

List the clinical features from a history of a UTI in children who can verbalise

A 
Increased frequency 
Painful urination 
Dysfunctional voiding
Incontinence
Abdo pain 
Loin tenderness 
Vomiting 
Fever
Malaise
Haematuria
Offensive smelling urine 
Cloudy urine
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12
Q

What should be gained from examination of a child with a fever?

A

Temperature
Heart rate
Respiratory rate
Capillary refill time

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13
Q

Give the clinical signs when acute pyelonephritis/Upper UTI should be suspected in a child?

A

Temperature of 38 or higher and bacteriuria

Temperature lower than 38 with loin pain/tenderness and bacteriuria

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14
Q

When should a lower UTI be considered?

A

No systemic symptoms but bacteriuria present

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15
Q

What should be examined when suspecting UTI?

A

Throat and cervical lymph nodes

Abdomen - constipation, masses, tender or palpable kidney

Back - stigmata of spina bifida or sacral agenesis

Genitalia - phismosis, labial adhesions, vulvitis, epidymo-orchitis

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16
Q

List the differential diagnosis of a UTI

A 
Vulvovaginitis 
Kawasaki disease
Voiding dysfunction 
Sepsis with no urinary tract source
Threadworms
Meningitis
17
Q

What investigations are required and when for UTI?

A

Clean catch urine sample for microscopy and culture within 24 hours in all infants with unexplained temp >38

Urine dipstick if UTI suspected

18
Q

What other methods can be used when clean catch is unobtainable

A

Urine collection pads
Catheter samples
Suprapubic aspiration

19
Q

What will a urine dipstick show if UTI is present?

A

Positive for Leukocyte esterase and nitrites

20
Q

What imaging is required for children under 6 months with a UTI?

A

Typical UTI - Ultrasound within 6 weeks

Atypical UTI - Ultrasound during acute infection, Dimercaptosuccinic acid (DMSA) 4-6 months after infection, micturating cystourethrogram (MCUG)

Recurrent UTI - Ultrasound during acute infection, DMSA 4-6 months after, MCUG

21
Q

What imaging is required for patients older than 6 months with a UTI?

A

Typical UTI - No imaging

Atypical UTI - Ultrasound during infection and DMSA 4-6months after

Recurrent - DMSA 4-6 months after and MCUG

22
Q

List some features of an atypical UTI

A 
Poor urine flow 
Abdominal or bladder mass
Raised creatinine
Sepsis
Failure to respond to treatment within 48hrs
Non E.col organism
23
Q

Define recurrent UTI

A

> 2 episodes or upper UTI
1 episode of upper UTI and one episode of lower UTI
Three episodes of lower UTI

24
Q

What information does ultrasound give of the kidneys

A

Size, congenital abnormalities, renal calculi, hydro nephrosis, obstruction, reflux

25
Q

What information does micturating cystography give?

A

Gold standard investigation for reflux and provides info about the urethra

26
Q

What are the problems with micturating cystography?

A

Invasive and requires catheterisation

27
Q

What is DMSA scintigraphy gold standard for detecting?

A

Renal parenchyma defects and scarring

28
Q

Describe the management of a child <3months old with suspected UTI

A

Refer to paediatric specialist for urine analysis and treatment with parenteral antibiotics

29
Q

Describe the management of children >3months with lower UTI

A

Oral antibiotics for 3 days - trimethoprim, nitrofurantoin, cephalosporin, amoxicillin (choose according to local guidelines)

Advise parents to return if child still unwell 24-48hrs later

30
Q

Describe the management of a child >3 months with upper UTI

A

Referral to paeds specialist considering:

  • Age
  • How unwell child is - can they tolerate oral ABx?
  • Inadequate fluid intake 50-75% usual volume/no wet nappy >12hrs
  • Factors indicating parent can not look after child/recognise deterioration

If admission not appropriate then oral antibiotics, ciprofloxacin or co-amoxiclav for 7-10 days

31
Q

How should asymptomatic bacteriuria be managed?

A

No antibiotics

32
Q

What advice should be given to parents of a child with a UTI

A 
Complete full course of ABx
Paracetamol for pain relief
Adequate fluid intake
Not to delay voiding 
Have access to clean toilet
Constipation should be addressed
Symptoms of UTI and safety netting
33
Q

List some complications of UTI

A

Renal scarring/damage/ insufficiency/failure

Hypertension

Possible link between bacteriuria and hypertension in pregnancy in future with history of childhood UTI

34
Q

When is recurrence of UTIs more likely?

A

Children <6months
Girls compared to boys
VUR grade 3-5
Voiding abnormalities

35
Q

Describe vesicoureteral reflux

A

Reflux of the urine from the bladder into the ureter
Affects a third of children with UTI
Can be uni/bilateral

Paediatrics finals (37 decks)

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