Urinary Tract Infection
NICE guideline summaried (other to read RCH, TDA top down approach, AAP, ISPN italian)
Hx
Fever
Vomiting
Lethargy
Irritability
Anorexia
FTT
Vomiting
Abdo/loin pain
Jaundice
Haematuria
Offensive urine
Ix
Clean catch
In/out
SPA
MCS, blood, protein
BP
No symptoms = no infection (i.e. if found incidentally)
Dip- Nitrates on fresh sample = infection, Leuks non-specific
Urgent Micro. Bacteriuria = infection, pyuria non-specific
Bacteriuria and loin pain OR fever = Upper, otherwise lower
If unwell start ABs before result
PO if >6mo uncomplicated for 5 days
IV/IM if <6m or septic or pyelonephritis 48 hours then complete 10 days
(use different antibiotic if on prophylaxis)
Repeat urine 48 hours after completion (eTG says yes, NICE says no)
Risk factors for serious pathology
Atypical
Other
Ix
US (acute) any atypical, or <6m with recurrent
US (6/52): if <6/12 and not done acutely OR any recurrent
MCUG: if <6/12 with atypical OR recurrent (needs prophylaxis for 3 days i.e. 1d before to 1d after)
DMSA (in 4/12): any recurrent OR <3yo with atypical (earlier if recurrence within that 4m)
Prevention
Prophylaxis for recurrent UTI, VUR (surgery not routinely recommended) (reduced UTI by 50% but not scarring)
Treat constipation
Post void scan > bladder training
Hydration
Don't delay voiding
Circumcision (90% reduction in <1yo boy, 30% reduction in men)
Nephrologist if
Education
Hx
Fever
Vomiting
Lethargy
Irritability
Anorexia
FTT
Vomiting
Abdo/loin pain
Jaundice
Haematuria
Offensive urine
Ix
Clean catch
In/out
SPA
MCS, blood, protein
BP
No symptoms = no infection (i.e. if found incidentally)
Dip- Nitrates on fresh sample = infection, Leuks non-specific
Urgent Micro. Bacteriuria = infection, pyuria non-specific
Bacteriuria and loin pain OR fever = Upper, otherwise lower
If unwell start ABs before result
PO if >6mo uncomplicated for 5 days
IV/IM if <6m or septic or pyelonephritis 48 hours then complete 10 days
(use different antibiotic if on prophylaxis)
Repeat urine 48 hours after completion (eTG says yes, NICE says no)
Risk factors for serious pathology
Atypical
- Non-E.coli
- Abdominal / bladder mass
- Poor urine flow
- Raised creatinine
- Septicaemia
- Limited response at 48 hours
Other
- Possible previous UTI
- Antenatally-diagnosed renal abnormality
- Family history of VUR or renal disease
- Constipation
- Dysfunctional voiding
- Enlarged bladder
- Evidence of spinal lesion
- FTT
- HTN
Ix
US (acute) any atypical, or <6m with recurrent
US (6/52): if <6/12 and not done acutely OR any recurrent
MCUG: if <6/12 with atypical OR recurrent (needs prophylaxis for 3 days i.e. 1d before to 1d after)
DMSA (in 4/12): any recurrent OR <3yo with atypical (earlier if recurrence within that 4m)
Prevention
Prophylaxis for recurrent UTI, VUR (surgery not routinely recommended) (reduced UTI by 50% but not scarring)
Treat constipation
Post void scan > bladder training
Hydration
Don't delay voiding
Circumcision (90% reduction in <1yo boy, 30% reduction in men)
Nephrologist if
- Cr, HTN, proteinuria or Bilateral renal anomaly
Education
- the nature of and reason for UTIs
- recognising symptoms quickly
- urine collection, storage and testing
- the need for treatment, the importance of completing treatment and advice about prevention and long-term management (if appropriate)
- prognosis
- prevention