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Morning Report

Morning Report. August 3, 2010. UTIs. Lower Bladder Urethra Upper Kidneys Renal pelvis Ureters. Risk Factors. Age Infants Teenagers Sex First 3 postnatal months Males First 6 years Females. Risk Factors. Previous history Sibling with UTI Catheterization

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Morning Report

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  1. Morning Report August 3, 2010

  2. UTIs • Lower • Bladder • Urethra • Upper • Kidneys • Renal pelvis • Ureters

  3. Risk Factors • Age • Infants • Teenagers • Sex • First 3 postnatal months • Males • First 6 years • Females

  4. Risk Factors • Previous history • Sibling with UTI • Catheterization • Structural Abnormalities • Most important risk factor for the development of pyelonephritis??

  5. Common Bugs • E.coli • 90% • Enterobacter • Proteus • Kebsiella

  6. Defense • Empty bladder regularly

  7. Signs and Symptoms • Older children • Fever • Chills • Nausea/Vomiting • Flank pain • Dysuria • Urgency • Frequency • Suprapubic or CVA tenderness • Younger children and infants • Fever • Irritability • Poor feeding • Lethargy • Abd pain • Vomiting • Loose stools

  8. To Bag or Not to Bag? • Bag specimen • Urethral catheterization • Suprapubic aspiration • Clean Catch • Older children

  9. Results • Leukocyte esterase • WBCs • Nitrites • Bacteria • Gram stain

  10. Results • Pyelonephritis • Elevated peripheral WBC count • ESR • CRP • None are sensitive or specific enough to include or exclude

  11. Results • Culture results • Diagnostic confirmation • Suprapubic tap • Any growth • Cath • >50,000 • Midstream Catch • >100,000

  12. Imaging • Not needed to confirm diagnosis of pyelo • U/S • CT • More sensitive • DMSA • Test of choice • Detects renal scarring • Not routinely used

  13. Treatment • Local microbial resistance patterns • Hospitalization - IV • Ampicillin and gentamicin • 1st, 2nd or 3rd generation cephalosporins • Bactrim • Penicillin/beta-lactamase inhibitor combos • IV meds until afebrile for 24 hours • Can give IM dose followed by PO for uncomplicated pyelo

  14. Treatment - PO • Amoxicillin • 40% are resistant • Bactrim • Do not use if local resistance is over 10-20% • 1st, 2nd or 3rd generation cephalosporins • Penicillin/beta-lactamase inhibitor combos • Cipro • Always tailor based on cultures • 10-14d

  15. Follow up • No f/u culture needed • < 5 years old • Antibiotics until work up complete • Renal U/S • VCUG • Older children may warrant eval if febrile UTI or pyelonephritis occurs

  16. VUR

  17. Complications • Bacteremia • Obstruction • Abscess • Recurrence • Renal Scarring • HTN

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