Pediatric Urinary Tract Infections

Pediatric Urinary Tract Infections
By: Joshua A. Hodge, Maj, USAF, MC
Staff Family Physician
Andrews AFB, MD

Overview
* Background
* Diagnosis
* Treatment
* Follow up
* Prevention
* Imaging
* Vesiculoureteral reflux (VUR)
* Summary

Diagnosis
* Single organism identified on culture
* Urinalysis
* Blood cultures not useful

Treatment
* Initiate immediately after culture drawn
* Oral route preferred
* 7-14 day course is standard

Follow Up
* AAP Recommendation: 48 hours
Prevention

* Rates of recurrence
* Prophylactic antibiotics
* Circumcision

Imaging
* Who to image?
o AAP
* Renal ultrasound
o GU tract anatomy
o Evaluate renal scarring
* DMSA (renal cortical scan)
o Differentiates pyelonephritis from cystitis
o Assesses renal scarring
* Cystogram- identify and grade vesicoureteral reflux (VUR)
o Voiding cystourethrogram (VCUG)
o Radionuclide cystogram (RNC)

Vesicoureteral Reflux (VUR)
* Concern for pyelonephritis & renal scarring
* Prevalence in females
* Standard treatment options
* Unclear if clinical benefits to treating VUR

Summary
* Urine culture necessary for diagnosis
* Short courses of antibiotics may be as effective as longer courses
* Prophylactic antibiotics are an option but may not provide much clinical benefit
* Routine imaging does not appear to affect outcomes
* Diagnosing VUR does not appear to affect outcomes

References
Pediatric Urinary Tract Infections.ppt