Urinary tract infection (peds) - Revision history

Rossdonaldson1: /* See Also */

2020-06-04T19:26:22Z

Rossdonaldson1: /* Evaluation */

2020-06-04T19:26:03Z

Evaluation

← Older revision		Revision as of 19:26, 4 June 2020
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	==Evaluation==		==Evaluation==
	*[https://uticalc.pitt.edu/ University of Pittsburgh UTI Calc]		===Workup===
	*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]

	===~~Labs~~===
	*[[Urinalysis]]		*[[Urinalysis]]
	**Obtain clean catch specimen '''OR''' cath UA		**Obtain clean catch specimen '''OR''' cath UA
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	**Do not send urine bag specimen for culture when UA is negative and clinical suspicion is relatively low<ref>Kim GA and Koo JW. Validity of bag urine culture for predicting urinary tract infections in febrile infants: a paired comparison of urine collection methods. Korean J Pediatr. 2015 May; 58(5): 183–189.</ref>		**Do not send urine bag specimen for culture when UA is negative and clinical suspicion is relatively low<ref>Kim GA and Koo JW. Validity of bag urine culture for predicting urinary tract infections in febrile infants: a paired comparison of urine collection methods. Korean J Pediatr. 2015 May; 58(5): 183–189.</ref>
	***False positives are high due to bag contamination		***False positives are high due to bag contamination

			===Diagnosis===
	<div><br></div><div>		<div><br></div><div>
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Rossdonaldson1 at 19:25, 4 June 2020

2020-06-04T19:25:08Z

← Older revision		Revision as of 19:25, 4 June 2020
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	*[https://uticalc.pitt.edu/ University of Pittsburgh UTI Calc]		*[https://uticalc.pitt.edu/ University of Pittsburgh UTI Calc]
	*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]		*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]

	===Labs===		===Labs===
	*[[Urinalysis]]		*[[Urinalysis]]

ClaireLewis: /* References */

2019-10-06T21:16:52Z

References

← Older revision		Revision as of 21:16, 6 October 2019
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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
			[[Category:ID]]
			[[Category:Urology]]

ClaireLewis at 20:44, 25 August 2019

2019-08-25T20:44:23Z

← Older revision		Revision as of 20:44, 25 August 2019
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	==Background==		==Background==
	*Most common SBI, accounts for 5-8% of children presenting for fever without clear source		*Most common SBI, accounts for 5-8% of children presenting for fever without clear source
	*Associated with bacteremia in up to 30% of infants ~~between~~ 4-8wk of age		*Associated with bacteremia in up to 30% of infants 4-8wk of age
	*[[E. coli]] is responsible for ~80% of UTIs		*[[E. coli]] is responsible for ~80% of UTIs
	*Do not use nitrofurantoin in children (need bloodstream penetration)
	*After 1yr of age, occult UTI with normal UA extremely rare		*After 1yr of age, occult UTI with normal UA extremely rare
	*After 2yr of age, UTI remains common in girls (but associated with symptoms)		*After 2yr of age, UTI remains common in girls (but associated with symptoms)
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	*Older children:		*Older children:
	**[[Dysuria]], frequency, or other urinary complaints		**[[Dysuria]], frequency, or other urinary complaints
	*+/- [[abdominal pain (peds)\|abdominal]]/[[back pain]]		**+/- [[abdominal pain (peds)\|abdominal]]/[[back pain]]
	*UTI + [[fever (Peds)\|fever]] = [[pyelonephritis]]		*UTI + [[fever (Peds)\|fever]] = [[pyelonephritis]]

ClaireLewis at 20:43, 25 August 2019

2019-08-25T20:43:39Z

← Older revision		Revision as of 20:43, 25 August 2019
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	*Most common SBI, accounts for 5-8% of children presenting for fever without clear source		*Most common SBI, accounts for 5-8% of children presenting for fever without clear source
	*Associated with bacteremia in up to 30% of infants between 4-8wk of age		*Associated with bacteremia in up to 30% of infants between 4-8wk of age
	*UTI + fever = pyelo
	*[[E. coli]] is responsible for ~80% of UTIs		*[[E. coli]] is responsible for ~80% of UTIs
	*Do not use nitrofurantoin in children (need bloodstream penetration)		*Do not use nitrofurantoin in children (need bloodstream penetration)
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	==Clinical Features==		==Clinical Features==
	*Infants/young children: ~~Fever~~ without other source		*Infants/young children: [[fever (Peds)\|fever]] without other source
	*Older children: ~~Urinary~~ complaints~~, abd~~/back pain		*Older children:
			**[[Dysuria]], frequency, or other urinary complaints
			*+/- [[abdominal pain (peds)\|abdominal]]/[[back pain]]
			*UTI + [[fever (Peds)\|fever]] = [[pyelonephritis]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	**Do not send urine bag specimen for culture when UA is negative and clinical suspicion is relatively low<ref>Kim GA and Koo JW. Validity of bag urine culture for predicting urinary tract infections in febrile infants: a paired comparison of urine collection methods. Korean J Pediatr. 2015 May; 58(5): 183–189.</ref>		**Do not send urine bag specimen for culture when UA is negative and clinical suspicion is relatively low<ref>Kim GA and Koo JW. Validity of bag urine culture for predicting urinary tract infections in febrile infants: a paired comparison of urine collection methods. Korean J Pediatr. 2015 May; 58(5): 183–189.</ref>
	***False positives are high due to bag contamination		***False positives are high due to bag contamination
	***Causes unnecessary interventions
	<div><br></div><div>		<div><br></div><div>
	{\| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="color: rgb(51, 51, 51); font-family: Verdana,Arial,Helvetica,sans-serif; width: 718px; height: 427px;"		{\| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="color: rgb(51, 51, 51); font-family: Verdana,Arial,Helvetica,sans-serif; width: 718px; height: 427px;"
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	==Management==		==Management==
	*Know your local resistance patterns and make sure to send a urine culture		*Know your local resistance patterns and make sure to send a urine culture
			*Do not use [[nitrofurantoin]] in children (need bloodstream penetration)

	===<1mo===		===<1mo===
	*Admit for IV [[antibiotics]]		*Admit for IV [[antibiotics]]
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	===1mo - 2yo===		===1mo - 2yo===
	*[[Ceftriaxone]]		*[[Ceftriaxone]] 50mg/kg in ED
	**3rd gen cephalosporin		*[[Cephalexin]] 50-100mg/kg/d in 4 divided doses x14d
	**50mg/kg in ED
	*[[Cephalexin]]
	**2nd gen cephalosporin
	**50-100mg/kg/d in 4 divided doses x14d
	**Maximum dose (all ages) 4g/24hr		**Maximum dose (all ages) 4g/24hr

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	*[[Amoxicillin]]		*[[Amoxicillin]]
	**Mild to moderate infections (>40kg): 500mg PO BID for x10-14d		**Mild to moderate infections (>40kg): 500mg PO BID for x10-14d
	*[[Cephalexin]]		*[[Cephalexin]] 50-100mg/kg/d in 4 divided doses x7d
	**2nd gen cephalosporin		*[[Cefaclor]] 50-100 mg/kg/d divided in 3 doses x5d
	**50-100mg/kg/d in 4 divided doses x7d		*[[Cefixime]] 8 mg/kg daily x 5d
	*[[Cefaclor]]
	**2nd gen cephalosporin
	**50-100 mg/kg/~~Day~~ divided in 3 doses x5d
	*[[Cefixime]]
	**3rd gen cephalosporin
	**8 mg/kg ~~once a day~~ x 5d

	===>13yr adolescent===		===>13yr adolescent===

Rossdonaldson1: /* Background */

2019-07-18T20:30:49Z

Background

← Older revision		Revision as of 20:30, 18 July 2019
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	''This page is for pediatric patients; see [[Acute cystitis]] for adult patients.''		''This page is for pediatric patients; see [[Acute cystitis]] for adult patients.''
	==Background==		==Background==
	*Most common SBI, accounts for 5-8% of children presenting for fever ~~w/o~~ clear source		*Most common SBI, accounts for 5-8% of children presenting for fever without clear source
	*~~Leukesterase has sensitivity of~~ up to 85%~~; nitrates have specificity~~ of 95-~~99%~~		*Associated with bacteremia in up to 30% of infants between 4-8wk of age
	*UTI + fever = pyelo		*UTI + fever = pyelo
	*~~Associated with bacteremia in up to 30% of infants between 4-8wk of age~~		*[[E. coli]] is responsible for ~80% of UTIs
	*E. coli is responsible for ~80% of UTIs
	*Do not use nitrofurantoin in children (need bloodstream penetration)		*Do not use nitrofurantoin in children (need bloodstream penetration)
	*After 1yr of age, occult UTI with normal UA extremely rare		*After 1yr of age, occult UTI with normal UA extremely rare

Gheid: /* Background */

2019-06-20T16:49:57Z

Background

← Older revision		Revision as of 16:49, 20 June 2019
Line 1:		Line 1:
	''This page is for pediatric patients; see [[Acute cystitis]] for adult patients.''		''This page is for pediatric patients; see [[Acute cystitis]] for adult patients.''
	==Background==		==Background==
			*Most common SBI, accounts for 5-8% of children presenting for fever w/o clear source
			*Leukesterase has sensitivity of up to 85%; nitrates have specificity of 95-99%
			*UTI + fever = pyelo
			*Associated with bacteremia in up to 30% of infants between 4-8wk of age
	*E. coli is responsible for ~80% of UTIs		*E. coli is responsible for ~80% of UTIs
			*Do not use nitrofurantoin in children (need bloodstream penetration)
	*After 1yr of age, occult UTI with normal UA extremely rare		*After 1yr of age, occult UTI with normal UA extremely rare
	*After 2yr of age, UTI remains common in girls (but associated with symptoms)		*After 2yr of age, UTI remains common in girls (but associated with symptoms)
	*Associated with bacteremia in up to 30% of infants between 4-8wk of age
	*Do not use nitrofurantoin in children (need bloodstream penetration)
	*UTI in adolescent girl is suggestive of intercourse		*UTI in adolescent girl is suggestive of intercourse
	*Prevalence of UTI in [[bronchiolitis]] is only 0.8% based on 2019 meta-analysis, which is far lower than in previous studies, suggesting less need for automatic testing for UTI in bronchiolitis<ref>McDaniel CE et al. Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(3):269-277. doi:10.1001/jamapediatrics.2018.5091.</ref>		*Prevalence of UTI in [[bronchiolitis]] is only 0.8% based on 2019 meta-analysis, which is far lower than in previous studies, suggesting less need for automatic testing for UTI in bronchiolitis<ref>McDaniel CE et al. Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(3):269-277. doi:10.1001/jamapediatrics.2018.5091.</ref>

Kxl328: /* Evaluation */

2019-05-27T04:32:55Z

Evaluation

← Older revision		Revision as of 04:32, 27 May 2019
Line 19:		Line 19:

	==Evaluation==		==Evaluation==
			*[https://uticalc.pitt.edu/ University of Pittsburgh UTI Calc]
	*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]		*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]
	===Labs===		===Labs===

Kxl328: /* Background */

2019-05-25T17:48:48Z

Background

← Older revision		Revision as of 17:48, 25 May 2019
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	*Do not use nitrofurantoin in children (need bloodstream penetration)		*Do not use nitrofurantoin in children (need bloodstream penetration)
	*UTI in adolescent girl is suggestive of intercourse		*UTI in adolescent girl is suggestive of intercourse
	*Prevalence of UTI in [[bronchiolitis]] is only 0.8% based on 2019 meta-analysis, which is far lower than in previous studies, suggesting less need ~~to test~~ for UTI in bronchiolitis<ref>McDaniel CE et al. Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(3):269-277. doi:10.1001/jamapediatrics.2018.5091.</ref>		*Prevalence of UTI in [[bronchiolitis]] is only 0.8% based on 2019 meta-analysis, which is far lower than in previous studies, suggesting less need for automatic testing for UTI in bronchiolitis<ref>McDaniel CE et al. Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(3):269-277. doi:10.1001/jamapediatrics.2018.5091.</ref>

	==Clinical Features==		==Clinical Features==

← Older revision		Revision as of 19:26, 4 June 2020
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	==See Also==		==See Also==
	*[[Urinary tract infections]]		*[[Urinary tract infections]]

			==External Links==
			*[https://uticalc.pitt.edu/ University of Pittsburgh UTI Calc]
			*[https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinical-pathway Children's Hospital of Philadelphia UTI pathway]

	==References==		==References==