voids frequently or the urine is diluted → no

urinary stasis → no bacterial contamination

Common Etiologic Agents

 Escherichia coli

ion

Note:

 Promptly plate the urine sample (if urine sits at room

temperature for >60 minutes → overgrowth of a minor

contaminant → falsely suggest UTI)

 Place sample in refrigerator until it can be cultured.

 If patient voids frequently or the urine is diluted → no

urinary stasis → no bacterial contamination

Common Etiologic Agents

 Escherichia coli

 Klebsiella

 Proteus – common in male infants more than 1 yo, as

common as E. coli

 Staphylococcus saphrophyticus

 Viral infections (adenovirus) may also occur especially as

a cause of cystitis

Algorithm – please look at last page

 Suspected UTI  patient has fever? (diferentiates acute

pyelo and cystitis)  ask risk factors (VUR, most important

risk factors for Acute Pyelo)  Diagnostics: Urine Culture,

CBC, Ultrasound, ESR and CRP (non specific for

inflammation), VCUG to dx VUR

 Pyelonephritis – infant (IV), > 3 months (oral 3rd gen ceph,

Cefixime)
 Cystitis – 3-5 days treatment

**VCUG is done if refluxwhen already afebrile)

 Drugs: (must be broad-spectrum & active against g(-))

o Ampicillin + aminoglycoside (gentamycin)

o Ceftriaxone (in milder cases)

o Cefotaxime

o Cefixime

when already afebrile)

 Drugs: (must be broad-spectrum & active against g(-))

o Ampicillin + aminoglycoside (gentamycin)

o Ceftriaxone (in milder cases)

o Cefotaxime

o Cefixime

VVV is suspected

Prophylactic antibiotics for possible recurrence

Imaging Studies:

 Goal of imaging studies in children with UTI

o Identify anatomic abnormalities that predispose

them to infection

o Determine whether there is active renal

involvement

o Assess whether renal function is normal or at risk

Ultrasound

Demonstrates:

 Hydronephrosis

 Renal or perirenal abscess

 Enlarged kidneys (30-60% of cases)

 Renal scars (30%)

 Pyonephrosis
 Urinary bladder capacity

 Post-void residual – after voiding you can allow up to 10 ml

residual volume

 Wall thickness – a thick bladder wall may be cystitis

DMSA Renal Scan

**Dimercaptosuccinic acid – take

Drug Dosage

(mg/kg/dose)

Frequency (hours)

Cephalexin

Cotrimoxazole (TMP-SMX)

Nitrofurantoin

Nalidixic Acid

10

2 of TMP

1-2

15

Single dose

Single dose

Single dose

Q 12

o Give only 30-35% of the original dose.

o We don’t want broad-spectrum drugs since these will lead to

further resistance).

o For older children, given at night (since at this time, urine stays

in the bladder)

o For infants, give anytime (since they can’t hold their urine)

Prevention of UTI
 Educate the caregiver!

o Urine monitoring (↑ risk of recurrence within the

next 6 months)

o Determine those with high index of suspicion

o Avoid constipation (causes incomplete

bladder emptying)