ShiShi

Is it a UTI?

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

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)

Treatment

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

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

Ask the nephrologist

300

All children age 2-24 months should have renal US after 1st febrile UTI

True

400

How do you check for renal scarring?

DMSA (dimercaptosuccinic acid) scan

Incidence of scarring doubles after 2nd febrile UTI

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