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TAS Nephrology > Urinary Tract Infection ✅ > Flashcards

Urinary Tract Infection ✅ Flashcards

1
Q

What is the most common bacterial infection in childhood?

A

UTI

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2
Q

Which gender are UTIs more common in?

A

Girls (except in early infancy, when boys get more)

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3
Q

What % of girls will experience a UTI by 10 years old?

A

8%

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4
Q

What % of boys will experience a UTI by 10 years old?

A

1%

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5
Q

What is diagnosis of UTI based on?

A

Urine microbiology

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6
Q

What type of urine sample is usually the best for urine microscopy?

A

Clean catch midstream sample

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7
Q

What other method of urine collection does NICE advocate for?

A

Absorbent urine collection pads

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8
Q

What urine collection method does NICE not recommend the use of?

A

Adhesive plastic bags

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9
Q

What urine sample collection method can be used in certain circumstances?

A

Catheter sample or suprapubic aspiration

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10
Q

When might catheter sample urine or suprapubic aspiration be used to obtain a sample in UTI?

A

In severely ill infants under 1 year of age, where an urgent diagnosis and early start of antibiotics is indicated

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11
Q

What does the bacterial growth rate that is considered to be significant on urine samples depend on?

A

The mode of collection

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12
Q

What bacterial growth rate is significant with a clean catch urine sample?

A

100,000 CFU/ml

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13
Q

What bacterial growth rate is significant with a catheter urine sample?

A

50,000 CFU/ml

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14
Q

What bacterial growth rate is significant with a suprapubic aspiration urine sample?

A

Any growth

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15
Q

How useful is urinary WBC?

A

Presence or absence alone is not reliable

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16
Q

What other conditions may cause a raised urinary WBC?

A
  • Febrile children
  • Balanitis
  • Vulvovaginitis
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17
Q

What can cause a false raise in urinary WBCs?

A

Lysis during storage

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18
Q

What is suggestive of UTI on urine dip?

A

Positive for leukocyte esterase and nitrates

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19
Q

What is the most common organism causing community acquired UTI?

A

E. coli

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20
Q

What % of childhood UTIs are E. coli?

A

75%

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21
Q

What are the other important organisms causing UTIs?

A
  • Enterococci
  • Klebsiella
  • Proteus
  • Serratia
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22
Q

What is the most important contributing factor to the development of UTIs?

A

Urinary stasis

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23
Q

What can cause urinary stasis?

A
  • Anatomical obstruction
  • Vesico-ureteric reflux
  • Incomplete or inefficient voiding habits
  • Low fluid intake
  • Constipation
24
Q

What other factors are important in the development of UTIs?

A
  • Periurethral colonisation

- Impaired host defence

25
Q

Give an example of when you might get periurethral colonisation?

A

In phimosis

26
Q

What should empirical treatment with antibiotics be based on?

A

Local knowledge of prevalent strains and their sensitivities

27
Q

What should be done if there is no response to empirical antibiotics within 24-48 hours?

A

A review of culture report and change in antibiotic should be considered

28
Q

What investigations might be used in UTI?

A
  • Abdominal USS
  • DMSA scan
  • MCUG
29
Q

When is an abdominal USS done in UTI?

A
  • Under 6 months with typical UTI

- Atypical or recurrent UTIs

30
Q

What is considered an atypical UTI?

A
  • Seriously ill
  • Poor urine flow
  • Abdominal or bladder mass
  • Sepsis
  • Raised creatinine
  • Failure to respond to suitable antibiotics within 48 hours
  • Infection with non-E.Coli organisms
31
Q

What is considered to be a recurrent UTI?

A
  • 2 or more episodes of UTI with acute pyelonephritis/upper urinary tract infection
  • 1 episode of UTI with acute pyelonephritis/upper urinary tract infection, plus 1+ episode of UTI with cystitis/lower urinary tract infection
  • 3+ episodes of UTI with cystitis/lower urinary tract infection
32
Q

What is the advantage of USS in investigating UTIs?

A
  • Non-invasive
  • No radiation risk
  • Can identify serious structural abnormalities, as well as urinary obstruction
33
Q

Give 2 examples of serious abnormalities hat can be identified on USS?

A
  • Posterior urethral valve

- Pelvi-ureteric junction obstruction

34
Q

What might abdominal USS miss in UTI?

A

Renal scars

35
Q

What is the gold standard investigation for identifying renal scars?

A

DMSA scan

36
Q

When should DMSA scans be done?

A

4-6 months after acute UTI

37
Q

Why should DMSA scans be delayed until 4-6 months after the UTI?

A

To avoid false positive results secondary to acute renal parenchyma inflammation in pyleonephritis

38
Q

What might DMSA scans miss?

A

Significant vesico-ureteric reflux (VUR)

39
Q

What is the gold standard investigation for identification of significant VUR?

A

MCUG

40
Q

What simple measures can be taken to prevent recurrence of UTIs?

A
  • Adequate fluid intake
  • Avoiding constipation
  • Proper toilet hygiene
41
Q

Should routine antibiotic prophylaxis be used in the prevention of UTIs?

A

No

42
Q

When should routine antibiotic prophylaxis be considered for UTIs?

A
  • Recurrent UTI

- Significant VUR (grade 3+)

43
Q

What antibiotic is most often used for UTI prophylaxis?

A

Trimethoprim

44
Q

What antibiotics should be avoided for UTI prophylaxis?

A

Broad spectrum antibiotics such as amoxicillin

45
Q

Is repeat urine culture to check resolution advised in UTI?

A

No

46
Q

Which children with UTIs do not require follow up?

A

Those that do not qualify for routine investigation

47
Q

When should antibiotic prophylaxis be stopped in UTIs?

A

No evidence, but generally considered once the child becomes toilet trained

48
Q

What is required for any child with renal scarring?

A

Lifelong BP management

49
Q

In what % of children with renal scarring is hypertension reported in?

A

10%

50
Q

What do bilateral renal scarring increase the risk of?

A

CKD

51
Q

What is required when a child has bilateral renal scars?

A

Regular reviews for hypertension, proteinuria, and renal dysfunction

52
Q

What might be of benefit in boys with recurrent UTIs?

A

Circumcision

53
Q

What is the number needed to treat for circumcision to prevent UTIs in normal children?

A

100

54
Q

When is the number needed to treat lower for circumcision to be of benefit in UTIs?

A
  • Recurrent UTIs (11)

- High grade VUR (4)

55
Q

When should surgical correction of VUR be considered?

A

Recurrent UTIs and progression of renal scars

56
Q

What is the limitation of surgical correction of VUR?

A

Outcome has not been shown to be better than antibiotic prophylaxis alone

TAS Nephrology (16 decks)

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