Pediatric urinary tract infection.pptVIP

Pediatric urinary tract infection Scott Weissman, MD Fellows’ orientation 8 July 2009 Presentation of UTI in children Newborn (1-30 d) Non-specific signs/symptoms Considered as sepsis; neonates do not localize Infant/toddler (1 mo-4 yr) Fever Abdominal pain/vomiting/diarrhea (Pre)school-age/adolescent (4 yr-) Like adult presentation Dysuria/frequency Case presentation 10 d/o M p/w poor feeding, grunting, T 103.6 Taken to community ER, lethargic; w/u performed Txfer to CHRMC, where septic, in DIC Rx: fluid resuscitation, FFP, platelets, empiric amp/cefotax Responded well to interventions Urine culture negative, blood culture (+) GNR LP traumatic, unsuccessful x1; later repeat successful but xanthochromic, elev WBC, RBC and protein Case presentation (cont.) Previous medical history Prenatal ultrasound (+) B hydronephrosis No oligohydramnios, but labor induced @ 37 wk Good urinary output, stream; o/w appeared well Postnatal RUS (+) mod. hydronephrosis D/C home DOL #2 Cr 0.2 on DOL #7 at well-child check Hospital course Cr 0.8 Due to daily fevers, repeat RUS on HD #3 (+) multiple hypoechoic lesions in R renal parenchyma ID consultation re management of nephronia +/- ?CNS Issues in pediatric UTI Antenatal ultrasound dx of hydronephrosis Cost effectiveness of RUS at first UTI Septic complication of congenital abnormality Early-onset vs. late-onset E. coli infection GI txlocation vs. GI colonization/ascending UTI Length of therapy per presentation Diagnosis Bagged sample Easy, atraumatic Perineal contamination - useful only if negative Catheterized sample More difficult, may be traumatic, nurse can do Collection systems don’t allow discard first cc’s Bladder tap sample Must be performed by physician Minimal complications, lowest risk of contamination Etiologic agents Escherichia coli Concerns for increasing prevalence of ESBL- producing strains; eg, ST131 (O25:H4) Additional etiologic agents Urology patients: congenital abnormalities, post-surgical Pseudomonas aerugin