UTIs

Question 1

What is the most common cause of UTI in paediatrics?

Answer 1

Bacterial - E. coli

Question 2

What is the difference between pathophysiology of UTIs in neonates versus older children?

Answer 2

1. Neonates - bacteria reach urinary tract via blood stream

2. Older children - ascend urinary tract from perineum

Question 3

At what point do UTIs become more common in girls than boys?

Answer 3

At 3 months of age

Question 4

What are the risk factors for developing a UTI?

Answer 4

1. VUJ obstruction
2. Incomplete bladder emptying (constipation, infrequent voiding)
3. Poor hygiene - advise wiping front to back

Question 5

What is this a presentation of?

<4 years old, fever, vomiting, poor feeding, lethargy, crying.

Answer 5

UTI

Question 6

What is this a presentation of?

>4 years old, dysuria, frequency, loin/abdominal pain, incontinence, fever, vomiting.

Answer 6

UTI

Question 7

How is a UTI diagnosed in a child >3 years old?

Answer 7

1. Clean catch urine

2. Positive WCC and nitrates

Question 8

How is a UTI diagnosed in a child <3 years old?

Answer 8

1. Clean catch urine

2. Dip for WCC and nitrates, also need urine MCS.

Question 9

What should you exclude in a recurrent/atypical UTI in a child <6 months and how?

Answer 9

Reflux, with MCUG

Question 10

What is the next step in these scenarios of a child with a suspected UTI?

1. Leucocytes +, nitrates +
2. L -, N+
3. L+, N-
4. L-, N-

Answer 10

1. Start antibiotics
2. Start antibiotics
3. Await MCS before antibiotics
4. No antibiotics

Question 11

What do all children <6 months with their first UTI need and why?

Answer 11

1. USS

2. VUJ reflex, posterior valves, PKD

Question 12

What is the general management for children with a UTI?

Answer 12

1. Avoid constipation, increase oral fluids
2. Encourage full voiding and void twice
3. Treatment antibiotics
4. Prophylactic antibiotics for VUJ reflux

Question 13

What antibiotics are given to a child <3 months old with a UTI who is systemically unwell?

Answer 13

IV amoxicillin and gentamicin

Question 14

What antibiotics are given to a child >3 months old with a lower UTI?

Answer 14

3 days trimethoprim/nitrofurantoin/amoxicillin

Question 15

What antibiotics are given to a child >3months old with an upper UTI?

Answer 15

Admit, 7 days PO/IV trimethoprim/nitrofurantoin/amoxicillin

Question 16

What are the complications of a UTI and how do you assess?

Answer 16

1. Renal scarring - DMSA scan

2. HTN, CKD