Transcript UTI in Children

UTI in Children
NICE Guidelines
Mary Conroy
• Common condition
• May present with non specific symptoms
• Sequelae, heavy burden on NHS
Diagnosis < 3 months
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Fever
Vomiting
Lethargy
Poor feeding/FTT
Abdominal pain
/jaundice/haematuria/offensive urine
Diagnosis > 3 months
• Preverbal
Fever
Abdominal/loin pain
Vomiting
Lethargy
FTT
Haematuria
Offensive urine
• Verbal
Frequency
Dysuria
Dysfunctional voiding
Changes to continence
Pain
Cloudy/offensive urine
When to test urine
• with symptoms and signs of UTI
• with unexplained fever of 38°C or
higher (test urine after 24 hours at the
latest).
• with an alternative site of infection but
who remain unwell (consider urine test
after 24 hours at the latest).
Collecting the urine sample
• A clean catch urine sample is the
recommended method for urine collection.
• – use other non-invasive methods such as
urine collection pads.
• – do not use cotton wool balls, gauze or
sanitary towels.
• If other non-invasive methods are not
possible:
• – use a catheter sample or suprapubic
aspiration
• Do not delay treatment if the sample cannot
be obtained and the infant or child is unwell
• Under 3/12 0 refer to paeds
• 3/12 – 3 years – urgent miscroscopy and
culture + Abx or MC&S + Abx
Microscopy
Pyuria
Positive
Pyuria
Negative
Bacteriuria
Positive
Treat
Treat
Bacteriuria
Negative
Treat on clinical No treatment
grounds
needed
Urine dipstick
Nitrite
Positive
Nitrite
Negative
Leukocyte
Positive
Treat
MC&S
Leukocyte
Negative
Treat if fresh
sample MC&S
Treat on clinical
grounds
MC&S
No treatment
required
Management
• Under 3/12 refer
• Upper UTI/Pyelonepritis, consider referral
Cef or Augmentin 7-10 days
• Lower UTI, oral antibiotics 3 days eg
trimethoprim, nitrifurantoin, amoxicillin
Prevention
• Hydration
• Try not to delay voiding
• Address dysfunctional elimination
syndromes and constipation
Investigation < 6/12
• Typical UTI (responds to Tx 48hr)
- US within 6 weeks
• Atypical UTI/ Recurrent UTI
- US during acute infection, DMSA,
MCUG
6/12 – 3 years
• Typical UTI – nil
• Atypical UTI – US during acute infection
DMSA
• Recurrent – US
DMSA
Over 3 years
• Typical UTI – Nil
• Atypical UTI – US acute
• Recurrent UTI – US
DMSA
Follow up
• Refer recurrent UTI and abnormal imaging
• Renal parenchymal defects – monitor
height, weight, BP and proteinuria
• Long term follow up: bilateral renal
abnormalities, impaired renal function, BP,
proteinuria under paeds nephrologist to
slow progression to CKD
Summary
• Consider UTI in the febrile child
• Refer <3/12, consider in upper
UTI/Atypical UTI
• Typical UTI > 6/12 – no need for
investigation