1、2007Risk factors for UTIPoor urine flowPrevious proved or suspected UTIRecurrent fever of unknown originAntenatally diagnosed renal abnormalityFamily history of vesico-ureteric refluxconstipationRisk factors for UTIDysfunctional voidingEnlarged bladderAbdominal massEvidence of spinal lesionPoor grow
2、th high blood pressureUrine samplingA clean catch sample should be obtainedIf not possibleUse non invasive method i.e.Urine collection padDo not use cotton wool balls,gauze or sanitary towels.If non invasive method not possibleUse catheter sample or suprapubic aspirationSymptoms and signsAge 3/12 pr
3、everbalMost commonFeverLess commonAbdominal pain,loin tenderness,vomiting,poor feeding.Least commonLethargy,irritability,haematuria,offensive urine,failure to thrive.Symptoms and signsAge 3/12 verbalMost commonFrequency,dysuriaLess commonDysfunctional voiding,changes to continence.Abdominal pain,loi
4、n tenderness.Least commonFever,malaise,vomiting,haematuria,offensive urine,cloudy urineMicroscopy resultsPyuria positivePyuria negativeBacteria positiveTreat as though has UTITreat as though has UTIBacteria negativeAntibiotic treatment to start if clinically has UTITreat as though does not have UTIM
5、anagement 3/12 3/12 3/12 3/12 3 MonthsWith acute pyelonephritis/upper UTIConsider referral to paediatriciansTreat with oral antibiotics for 7-10 days(cephalosporin or co-amoxiclav)If oral antibiotics not suitable give IV(cefatoxime or ceftriaxone)for 2-4 days then orallyAge 3 monthsWith cystitis/low
6、er UTITreat with oral antibiotics for 3 days choice depending on local resistance patternsParents should be advised if child still unwell after 24-48hrs to bring back for reassessmentIf no alternative diagnosis made a urine sample should be sent for culture.Prophylactic antibiotics should not routin
7、ely be given in children following first time UTI.Imaging should be carried out as per guidelinesIndications for cultureDiagnosis of acute pyelonephritis/upperUTIHigh or intermediate risk of serious illnessSingle positive result on dipstick testing Recurrent UTIInfection that does not respond to tre
8、atment in 24-48hrsClinical symptoms and dipstick testing dont correlateLocalising site of infectionAcute pyelonephritis/upperUTIBacteriuria and fever 38C or higherBacteriuria,loin pain/tenderness and fever less than 38CCystitis/lowerUTIBacteriuria but no systemic featuresPreventing recurrenceAddress
9、 dysfunctional voiding syndromesManage constipationEncourage children to drink adequate amountsAdvise not to delay voidingImagingAge 6/12 but 3yrsResponded to treatment in 48hrs No imaging requiredAtypical UTI Ultrasound during acute infection DMSA at 4-6/12Recurrent UTI Ultrasound within 6/52 of in
10、fection DMSA at 4-6/12ImagingAge 3yrs or olderResponds well to antibiotics within 48hrs No imaging requiredAtypical UTI Ultrasound during acute infectionRecurrent UTI Ultrasound within 6/52 DMSA at 4-6 monthsReferral and assessmentThose who have recurrent UTI or abnormal imaging results should be assessed by paediatric specialistThose who do not require imaging do not need specialist assessmentAssymptomatic bacteriuria does not require follow up
