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Duong Tu, MD Texas Children’s Hospital

When is a UTI not a UTI?

Definitions

•  Bacteriuria •  Pyuria •  Urinary Tract Infection (UTI)

– Complicated vs Uncomplicated – Recurrent

•  Reinfection vs bacterial persistence – Cystitis vs pyelonephritis

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Key Points to a UTI

Symptoms

Inflammation

Bacteria

Symptoms •  Infants and children < 2

– Vague symptoms – None are reliable

predictors of UTI

•  Older children and adolescents – Better localized to

urinary tract

•  Febrile UTI = pyelonephritis

Urinary Tract Infections Signs and Symptoms

Infants and Toddlers Older Children

Irritability Fever Failure to thrive Nausea/vomiting Diarrhea Hematuria Foul odor to urine

New-onset incontinence Foul odor to urine Frequency/urgency Pain with voiding Listlessness Irritability Unexplained fever Abdominal/flank pain

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Reliability of Urine Specimens

•  Depends on method of collection – Bag < voided < catheterization < suprapubic bladder aspirate

•  Bagged specimens – Optimize technique – Only useful if they are NEGATIVE – Need confirmation if POSITIVE

•  Circumcised vs Uncircumcised

Child (2 mo. – 2 years old)

Is the child ill?

Yes No

Immediate antibx,

Obtain specimen Obtain specimen

UA, UCx

Urethral catheterization

Suprapubic aspirate

UA, UCx

Bagged specimen

Suprapubic aspirate or

urethral catheterization

UA

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Is the child ill?

Yes

Immediate antibx

Obtain specimen

UA, UCx

Urethral catheterization

Suprapubic aspirate

Culture directed antibx therapy

Is the child ill?

No

Obtain specimen

UA, UCx

Bagged specimen

Suprapubic aspirate or

urethral catheterization

Culture directed antibx therapy

UA + UA

- UA

Suprapubic aspirate or

urethral catheterization

Culture directed antibx therapy

Follow clinical course w/o

antibx*

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Key Points to a UTI

Symptoms

Inflammation

Bacteria

Urinalysis

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Urinalysis

Urinalysis

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Key Points to a UTI

Symptoms

Inflammation

Bacteria

Confounders

•  Bacterial colonization – Clean Intermittent Catheterization (CIC) – Neurogenic bladder (NGB) – Bladder substitution / augmentation

•  Foreign bodies in the urinary tract •  Referred pain / voiding dysfunction •  Immunosuppression

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When to Refer? Abnormalities on Imaging

•  RUS •  VCUG

Febrile UTI (to rule out underlying causes)

•  2nd in girls •  1st in boys

Disorders of Elimination

•  Recurrent UTI •  VIP*

   

*Voiding Improvement Program