UTI

• What congenital condition can increase the risk of UTIs?

  Vesicoureteral reflux (VUR)

  Urine flows backwards from the bladder into ureters & kidneys
• What is the most common causative agent for UTIs?

  E.coli (80% of cases)

  Other pathogens:

  • Klebsiella pneumoniae
  • Proteus mirabilis
  • Enterococcus spp
  • Staphylococcus saprophyticus
• What are the signs & symptoms of lower UTIs (cystitis)?


  Dysuria

  Polyuria

  Urgency

  Haematuria

  Suprapubic pain or tenderness

  Foul-smelling urine

  Enuresis or daytime incontinence
• What are the signs & symptoms of upper UTIs (pyelonephritis)?


  Fever

  Flank pain or costovertebral angle tenderness

  Abdo pain

  Nausea & vomiting

  Lethargy or irritability

  Poor feeding or failure to thrive
• What are the signs & symptoms of UTIs in neonates?


  Non-specific symptoms

  • fever
  • hypothermia
  • jaundice
  • vomiting
  • diarrhoea
  • lethargy
  • poor feeding
  • failure to thrive

  Resp distress or apnoea

  Abdo distension
• What are the signs & symptoms of UTIs in infants & toddlers (3 months - 2 yrs)?


  Generalised symptoms

  • fever
  • irritability
  • lethargy
  • poor appetite
  • vomiting

  Strong-smelling urine

  Nappy rash
• What are the signs & symptoms of UTIs in 2-12 yrs old children?


  Lower urinary tract symptoms:

  • dysuria
  • frequency
  • urgency
  • hematuria

  Systemic symptoms:

  • fever with chills (more common in pyelonephritis)
  • abdominal pain
• What are the Inx for UTIs in children?


  Obs

  Full Hx & examination

  Urine dip

  Urinary microscopy & culture

  Consider bloods (FBC, U&Es, CRP, cultures)

  Renal/bladder USS
• What are the RFs of UTIs in children?


  Age < 1 yr

  Female

  Uncircumcised boys (1st year of life)

  Previous UTIs

  Bowel or bladder dysfunction

  Vesicoureteral reflux

  Sexual activity

  Anatomical abnormalities
• Fill in the blanks (urinalysis for UTI)

  A) +ve

  B) +ve

  C) Start Abx

  D) -ve

  E) +ve

  F) Start Abx

  G) +ve

  H) -ve

  I) Send for culture

  
• What is the management of UTIs in children?


  All children < 3 months with fever = IV Abx (ceftriaxone) + full septic screen (+ lumbar puncture)

  Children > 3 months who are otherwise well = PO Abx

  Children > 3 months who are unwell (features of sepsis or pyelonephritis) = IV Abx

  Typical Abx = trimethoprim, nitrofurantoin, cefalexin, amoxicillin (or co-amoxiclav)
• What are the features of atypical UTI?

  Seriously ill

  Poor urine flow

  Abdo or bladder mass

  Raised creatinine

  Septicaemia

  Failure to response to treatment with suitable Abx within 48 hrs

  Infection with non- E.coli organisms