Signs and symptoms of UTI - -Fever may be only sign infants a & young child
-Older children=urinary symptoms ( new onset incontinence, dysuria,
... [Show More] frequency,
abdominal pain
Risk factors of UTI - FEMALE, Uncircumcised male, GENETICS, (Anatomy),
BOWEL/BLADDER Dysfunction, Obstruction, Catheterization, SEX, Reflux
Exam for UTI - Temp, BP, abd exam for mass, tenderness. suprapubic or
costovertebral tenderness, check external genitalia, eval lower back for signs of
occult myelomeningiocele, check other sources for fever.
UTI testing - -clean catch, cath, suprapubic UA
*dipstick, urine culture.
-+ leukocyte esterase=pyuria
-+nitrate=bacteria
*C/S
-+100,000 colonies for dx; may treat 50,000 or greater
UTI cal app to estimate probability of UTI (ages 2 -23 months)
Indications for urine sample - Girls:
2-11 months of age temp > 100.4 (non-black)
2-11 months of age temp of 102.2 OR the,p 100.4 and no other fever source
identified.
12-24 months of age temp 102.2 (non black)
12-24 months of age 102.2 and no other source of fever identified.
>24 months One or more of the following: dysuria, frequency, new onset
incontinence, back pain, abdominal pain, fever of 102.2 and no other acute cause.
Infant UTI - non specific symptoms or asymptomatic
UTI symptom cluster - Newborn- irritability, poor feeding, diarrhea, fever,
vomiting. jaundice, hypothermia, cyanosis, lethargyInfants//todlers/preschool: diarrhea, vomiting, fever, poor feeding, strong urine
odor, irritability, poor weight gain, diaper rash
Schoolage/adolescents; fever, vomiting, strong urine odor, urethral pain or
suprapubic, dysuria, incontinence.
UTI differential diagnosis - Chemical irritation (bubble bath)
vulvovaginitis
dysfunctional voiding
acute abdomen ( appe, STD)
Foreign body
Sexual abuse
Dysfunctional voiding related to constipation
UTI specimen collection - Clean catch urine midstream
(bagged specimen don't do it)
Straight Cath for mod to severe symptoms
Suprapubic aspiration: only when culture is urgently needed. ( + is > 1000
colonies)
_blood culture obtained for <12months and suspected sepsis
Indications for radiology in UTI - -Symptoms of pyelonephritis regardless of age
and gender
-UTI in child <3 months
-males with first infection and females with second infection. even if not
pyelonephritis and child > 3 months of age.
UTI treatment - -IV ABX- newborns, infants, or older children with vomiting,
severe symptoms systemic illness or unable to take fluids
-ORAL- 10 day regimen, or 14 days with completed infection.
UTI drugs - 1. Bactrim ( infants >2 months) TMP 8-10mg/kg.BID Recommended
until sensitivities are back since most UTI are caused by E. coli.
2. Amoxicillin 30-40 mg/kg/day TID <3months
3. Augmentin 40mg/kg/day TID
4. Sulfisoxazole 150mg/kg/day QID
5. Cephalexin 50mg/kg/day TID
6. Nitrofurantin 5-7mg/kg/day in divided doses
(ideal treatment for UTI due to highly concentrated in the urine, but less effective
for systemic/renal infections as it does not concentrate well in blood) [Show Less]