Is it a UTI?
Treatment
Ask the nephrologist
100
Until what age should all febrile infants be evaluated with urinalysis and culture
Girls <12 months
Boys <6 months if circumcised
<12 months if uncircumcised
Any patient with symptoms to suggest UTI
200
How many colony forming units are indicative of UTI
>50,000 cfu on cath'd specimen
300
Name 3 clinical features of a patient suggestive of UTI
<2 yrs
Fever, especially if persisting >2 days
<12 months (girls), <6 months (cirumcised boys)
Absence of other infection
>2 yrs
Foul smelling urine
Suprapubic tenderness
Dysuria
Frequency
300
All children age 2-24 months should have renal US after 1st febrile UTI
True
400
A urine dipstick is sufficient in a patient with possible UTI
Leukocyte esterase sensitivity 94%, in clinically suspected UTI (83% in others), specificity is only ~70%
Positive nitrites is supportive
Negative nitrites is not a sensitive marker (needs to sit in the bladder with G- enteric bacteria for 4 hours to become positive)
400
Name 3 antibiotics that can be used to treat febrile UTI
IV
Ceftriaxone50 mg/kg, Q24 h (not if <1 month)
Cefotaxime150 mg/kg/d, Q6–8 h
Ceftazidime100–150 mg/kg/d, Q8 h
Gentamicin7.5 mg/kg/d, Q8 h
Tobramycin5 mg/kg/d, Q8 h
Piperacillin300 mg/kg/d, Q6–8 h
Oral
Amoxicillin-clavulanate20–40 mg/kg per d TID
SulfonamideTrimethoprim-sulfamethoxazole6–12 mg/kg/d trimethoprim and 30-60 mg/kg/d sulfamethoxazole BID (not if <2 mo)
Sulfisoxazole120–150 mg/kg/d QID
Cefixime8 mg/kg daily
Cefpodoxime10 mg/kg/d BID
Cefprozil30 mg/kg/d BID
Cefuroxime axetil20–30 mg/kg/d BID
Cephalexin 50-100mg/kg/d QID
400
How do you check for renal scarring?
DMSA (dimercaptosuccinic acid) scan
Incidence of scarring doubles after 2nd febrile UTI
500
All parents of children with UTI to be instructed to seek medical attention for subsequent febrile illnesses within what time frame?
Prompt and at least within 48 hours
500
Urologists recommend that a VCUG after 1st febrile UTI is not necessary
Incorrect, concerns regarding value and interpretation of studies in AAP guidelines led pediatric urologists to counter the guidelines with recommendation to still consider VCUG after 1st febrile UTI