Urinary Tract Infections

A really useful overview of UTIs in kids. One of the most common conditions that you will need to manage.

 

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Video Duration: 10 minutes

  • Urinary Tract Infections
    Created by Matthew Simkiss
    General
    Epidemiology

    "Defined as > 10^5 organisms per ml in voided urine”

    ~ 2% boys and ≥ 8% girls will develop a UTI during childhood

    • Neonates – infants:
      • Highest occurrence of UTI <1 yr
      • Usually acute pyelonephritis (M>F)
    • Children:
      • Incidence ↑ again after 2yrs
      • Usually cystitis (F>M)
    Pathology
    • Gram –ve bacteria such as E.coli (90%), S.faecalis, Klebsiella
    • Proteus
      • Under the prepuce (boys)
      • Associated with kidney stones
    • Staph saprophyticus – common in adolescent girls
    • Pseudomonas
      • Presence indicates congenital UT anomalies or
      • Acquired renal problems
    • Adenovirus
    Top three causes

    E.coli

    Clinical Features
    Symptoms
    • Neonates – infants:
      • Unexplained fever
      • Irritability
      • Febrile convulsions
      • Vomiting
      • Diarrhoea
      • Poor feeding
      • FTT
      • Prolonged neonatal jaundice
    • UTI symptoms in babies are VERY NON-SPECIFIC
      • Suspect if have fever, vomiting and diarrhoea
    • Children:
      • Fever +/- rigors
      • Dysuria
      • Frequency/ retention
      • Lethargy
      • Anorexia
      • Diarrhoea
      • Vomiting
      • Abdominal pain
      • 2⁰ enuresis
    Signs
    • General
      • Fever
      • Dehydration
      • Weight loss
    • Specific
      • Loin tenderness
      • Palpable bladder
    Investigations
    Cultures
    • Urine Collection
      • Infants:
        • A clean catch sample into a sterile pot or via suprapubic aspiration
        • Risk of contamination with adhesive plastic bags.
    • Children – MSU
    • Urine Dipstick
      • Screen for UTIs
      • Diagnosis = nitrites +/- leucocytes, blood or protein in 2 samples
    • Urine MC&S
      • UTI = 105 organisms/L of a pure growth
      • Contamination = Mixed organisms or epithelial cells
    Bloods
    • Bloods:
      • ↑ WCC
      • ↑ U&Es
      • ↑ CRP
      • Blood cultures (toxic child)
    Imaging

    USS

    Further radiological follow up if recurrent or involves kidneys to assess for urinary tract malformation

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Encourage feeding and fluids

    Medical
    • Prompt treatment is vital as risk of irreversible renal damage is high, especially in infants
    • < 3 months
      • IV amoxicillin & gentamicin
      • Or IV cephlasporin alone (Cefotaxime)
    • > 3 months: Oral Trimethoprim, Nitrofurantoin or Amoxicillin/co-amoxiclav
    • Children with cystitis (dysuria but no systemic symptoms or signs) can be treated with oral abx for 3 days
    Surgical

    None