UTI in Paediatrics

UTI in Paediatrics : 

UTI in Paediatrics Jackir Hussain

Case Study: 

Case Study 6 yr old girl GP referral Admitted with 10-15 episodes of vomitting – intermittent vomitting for 2 days Poor appetite Ongoing dysuria

History of PC : 

History of PC Seen by GP 4 days ago Abdominal pain Dysuria Commenced on Trimethoprim- began vomtting so switched to Nitrofurantoin – contined to vomit so referred to hospital

PMH: 

PMH Elective C-Section Vaccinations up to date Nil previous

Social History : 

Social History Twin older brothers 9 years old Half brother two years old Lives with twins, mum and grandmother Has a pet cat

Clinical Examination: 

Clinical Examination Alert and orientated Flushed No visible rashes / palpable lymph nodes Dry mucous membranes Clear chest Heart sounds normal, no added sounds or murmurs Abdo - generalised variable tendernesss , increased in left and right flanks, bilateral renal angle tenderness, BS present ENT- NAD Obs – Temp 40.2, HR 139, RR28, sats 98%on A , BP 117/68 weight 34.4kg

Investigations: 

Investigations Urine dipstick- 3+ ketones, 2+protein, 2+blood and 2+ leukocytes Blood U&E- NAD CRP 221 Gluc 5.6 FBC- WCC 19.3, Neut 15.41 LFTs- NAD

Investigations: 

Investigations MSU WCC 2241 RBC 160 No bacterial growth ( previous GP sample – mixed growth) USS – NAD

Management : 

Management Imp: Pyelonephritis IV fluids IV co- amoxiclav Analgesia Cyclizine

Current Guidelines UTI : 

Current Guidelines UTI Common Presenting complaint Acute pyelonephritis more common than in adults with febrile UTI Upper Tract- fever, lethargy, general malaise, vomitting , loin pain Lower Tract- Non-specific abdominal pain, urgency, frequency, wetting , haematuria Investigations Urine dipstick Urine sample – Clean catch, SPA, MSSU Urine microscopy – can make a useful contribution

UTI- Diagnosis & management : 

UTI- Diagnosis & management Usually ascending in origin Pure growth >10^5 bacterial colony forming units per ml Management Post sample treatment should be commenced immediately (especially <2) Best Guess policy (until sensitivities known) – no response 24-48hrs then change agent Short full dose course for 7 days IV therapy- hospital admission- 3 rd generation cephlasporin , or aminoglycaside and augmentin Prophylactic antibiotics

UTI – What Imaging and when?: 

UTI – What Imaging and when? All children with confirmed UTI require some form of urinary tract imaging 0-1 – USS DMSA scan- 3-6 months after infection Micturating Cystourethrogram – sterile urine and must be done urgently if gross dilatation of the collecting system or obstructive uropothy 1-5 – USS DMSA – recurrent UTI, Upper tract symptoms, FHx VUR/reflux nephropathy >5 –USS DMSA – as above AXR – Low sensitivity should be used in patients with haematuria, UTI secondary to proteus species and in a child with abnormal or delayed micturition

Parental advice : 

Parental advice Encourage regular and complete bladder emptying at least twice in the morning , afternoon and night Watching constipation and if necessary mild laxative Regular bathing avoid scented soap and bubble bath avoid shampooing child’s hair whilst in bath Clean front to back using soft absorbent paper Access to satisfactory toilets