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MBBS 3: Pediatrics > UTI > Flashcards

UTI Flashcards

1
Q

Epidemiology of UTIs?

A
  • Occurs in 5% of infants and young children with fever and no apparent source
  • Highest risk in uncircumcised boys < 3 mo and girls <12 mo
    Note: Most common bacterial infection in children < 2 years old
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2
Q

Untreated UTIs can lead to?

A

renal scarring

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3
Q

Overdiagnosis of UTIs can lead to?

A
  1. misuse of antibiotics
  2. unnecessary imaging
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4
Q

Signs and symptoms of UTIs?

A
  1. fever
  2. abdominal pain
  3. vomiting
  4. diarrhea
  5. new onset of urinary incontinence
  6. strong-smelling urine
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5
Q

Contributing factors in incomplete bladder emptying?

A

1, infrequent voiding - bladder enlargement
2. vulvitis
3. incomplete micturition with residual postmicturition bladder volumes
4. obstruction by a loaded rectum in constipation
5. neuropathic bladder
6. vesicoureteric reflux

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6
Q

Important question to ask in family history?

A

Ask about history of vesicoureteral reflux in parents and siblings

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7
Q

Clinical features in infants?

A
  1. fever
  2. vomiting
  3. lethargy/irritability
  4. poor feeding/faltering growth
  5. jaundice
  6. septicemia
  7. offensive urine
  8. febrile seizures (>6 months)
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8
Q

Clinical features of UTI in children?

A
  1. dysuria, frequency, urgency
  2. abdominal pain/loin tenderness
  3. fever
  4. lethargy and anorexia
  5. vomiting, diarrhea
  6. haematuria
  7. offensive/cloudy urine
  8. febrile seizure
  9. recurrence of enuresis
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9
Q

Methods of dipstick testing?

A
  1. nitrite stick testing
  2. leukocyte esterase stick testing (WBC)
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10
Q

Interpretation of nitrite stick testing?

A

+ result is likely indicative of a true UTI
- but some children with UTI may be nitrite -

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11
Q

Interpretation of leucocyte esterase stick testing?

A
  1. may be present in child with UTI
    - may also not be present
  2. present in febrile illness without UTI
    • in balanitis and vulvovaginitis
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12
Q

Diagnostic criteria of UTIs?

A
  1. urinalyis shows pyuria and/or bacteriuria
  2. urine culture grows >50,000 CFU/ml of bacteria
    Note: obtain urine specimen before giving antibiotics
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13
Q

3 ways to obtain urine culture?

A
  1. Suprapubic aspiration
    - Invasive, requires expertise, painful
    - May be necessary in boys with phimosis and girls with labial adhesions
  2. Catheterization
    - Invasive
    - High sensitivity (95%), specificity (99%)
  3. Bag applied to perineum
    - False positive result 88-99% of the time!
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14
Q

Risk factors for UTIs in girls?

A
  1. white race
  2. temp. >39 degrees
  3. fever lasting >2days
  4. no other source of infection
  5. age<12 months
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15
Q

Risk factors for UTI in boys?

A
  1. non black race
  2. temp. >39 degrees
  3. fever lasting >24 hours
  4. no other source of infection
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16
Q

In the lower likelihood of UTI what do you do?

A

clinically follow without testing

17
Q

In the event of higher likelihood of UTI what do you do?

A
  • Obtain urinalysis and culture by catheterization OR
  • Obtain urinalysis by bag or catheterization
    1. If urinalysis tests + for nitrites or leukocyte esterase, then obtain culture via catheterization
    2. If urinalysis tests negative, then follow clinically without antibiotic
18
Q

Treatment of UTIs?

A
  • Use oral or parenteral antibiotic
  • Adjust the antibiotic based on sensitivities from urine culture
  • Treat for 7-14 days for febrile UTI, 3-7 days for afebrile UTI
19
Q

Pathophysiology of UTI?

A

ascending infection
normal anatomy
1. E.coli
abnormal anatomy
1. vesicoureteral obstruction
2. uretropelvic junction obstruction
- citrobacter and enterococcus
Note: pyelonephritis - if infection gets to the kidney

20
Q

Examples of treatment regimens?

A
  1. Amoxicillin/clavulanate (Augmentin)
    - 20-40 mg/kg/day, divided q 8 hrs
  2. Ceftriaxone
    - 50-100/kg/day. Once a day
21
Q

Grading of vesicoureteral reflux?

A

Grade 1: reflux into the non-dilated ureter
Grade 2: reflux into the ureter and renal pelvis
Grade 3: reflux with mildly dilated ureter and pyelocalyceal system
Grade 4: reflux with the tortuous and moderately dilated ureter with with blunting renal fornices

22
Q

Common organisms that affect newborns (<30 days) and their treatment?

A

Organisms: GBS,Listeria Monocytogens Ecoli, Kelbsiella, Entrobactor, Coag Neg Staph, Enterococcus
Treatment: Amp (Xpen) and Gent

23
Q

Common organisms that affect young infants (30 to 60 days)?

A

Organisms: E.coli, Enterococcus Klebsiella
Treatment: Augumentin , Ceftriaxone

24
Q

Organisms that affect children over (60 days) and their treatment?

A

Organisms: E.coli, Kelbsiella, Proteus,Enterobactor, Pseudomonus Candida
Treatment: Cephalexin, Bactrim, Ceftriaxone, Nystatin

25
Q

Imaging modalities to confirm for UTI?

A
  1. renal and bladder ultrasound
  2. VCUG (voiding cystourethrogram)
26
Q

Pros and cons of renal and bladder ultrasound?

A

Pros: noninvasive, no radiation, can identify congenital anomalies of kidney, ureter and bladder; renal calculi, and hydronephrosis
Cons: cannot reliably demonstrate inflammation, renal scarring; no info on renal function

27
Q

Pros and cons of VCUG?

A

Pros: affects treatment decisions that theoretically reduce risk of renal scarring, is used primarily to diagnose and grade vesicoureteral reflux
Cons: radiation, expense, discomfort

28
Q

Imaging recommendations?

A
  1. Order renal and bladder U/S in febrile infants with confirmed UTI
  2. Order a VCUG if the U/S shows:
    - Hydronephrosis
    - Scarring
    - Other findings to suggest high-grade VUR or obstruction
  3. Perform a VCUG if a child develops a 2nd UTI
29
Q

Prevention of recurrent UTIs?

A
  1. Breastfeed
  2. Treat constipation
  3. Routine circumcision not recommended
  4. Use of daily prophylactic antibiotic is controversial
  5. high fluid intake to produce a high urine output
  6. regular voiding
  7. good perineal hygiene
  8. ensure complete bladder emptying - double voiding

MBBS 3: Pediatrics (40 decks)

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