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Peds UTI


Sporadic UTI = ≤ 1 UTI/6 mos and ≤ 2 UTIs/year
Recurrent UTI ≥ 2 UTIs/6 mos or ≥ 3 UTIs /year; Relapse / Reinfection
UTI epidemiology M>F until 6 mos; after 6 mos, F>M; by 2 yo, M:F 1:10
UTI prevalence in older 2-18 yo: 0.1-0.5% M, 1-5% F; adult F 1-3%
UTI s/s in newborns Fever, Sepsis, Jaundice, Vomiting, Failure to thrive
UTI s/s in infants/preschool Fever, Vomiting, FTT, Diarrhea, Abd/ flank pain, New onset incontinence; Dysuria; Urgency
UTI s/s in school age Fever; Vomiting; Abd/ flank pain; New onset incontinence; Dysuria; Urgency; Frequency
UTI dx UA & UCC; Blood tests; Radiologic studies
UA for UTI: LE & nitrite LE: about 80% sens/spec; nitrite 50% sens, 98% spec
RBC casts glomerulonephritis
Positive UCC = >100K if clean catch; >10K if cath; any growth if suprapubic
UTI blood labs CBC/diff; chem; blood cx; CRP
Distinguish upper vs lower UTI by: clinical judgement
UTI orgs E coli no. 1; Klebsiella 2nd most common; proteus M>F
UTI orgs uncommon in kids Enterococci (uncommon >1 month); coag neg staph, SA; GBS
Cystitis tx TMP/SMX; Cephalosporins (cephalexin, cefixime); Amox (?with clavulanate); 7 – 10 days
Fn of US & VCUG US: anatomy; VCUG: check for vesicoureteral reflux (Normal to Grade V)
Reflux 30% familial; Abx, surg (Reimplantation; Endoscopic placement of bulking agent)
Pts 2 mos-2 yo who don’t have expected clinical response within 2 days: US ASAP; VCUG or RNC at earliest convenience
Pts 2 mos-2 yo with expected clinical response within 2 days: US at earliest convenient time; VCUG or RNC strongly encouraged
Created by: Abarnard