Urinary Tract Infection (UTI) for 5th Grade
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Questions and Answers

What percentage of girls have a UTI during their prepubertal years?

  • 10%
  • 3% (correct)
  • 1%
  • 5%

    • Why are uncircumcised boys at a higher risk of developing a UTI during the first year of life?

  • Because of the bacteria beneath the prepuce (correct)
  • Because of a genetic predisposition
  • Because of poor hygiene
  • Because of a shorter urethra

    • What is the primary cause of UTIs?

  • Colonic bacteria (correct)
  • Fungal infections
  • Parasitic infections
  • Viral infections

    • What percentage of UTIs are caused by Escherichia coli?

    <p>54-67%</p> Signup and view all the answers

    What is the primary route of infection for UTIs?

    <p>Ascending infection</p> Signup and view all the answers

    What is the highest risk group for acute pyelonephritis and subsequent renal scarring?

    <p>Children younger than 2 years</p> Signup and view all the answers

    What is a rare route of infection for UTIs?

    <p>Hematogenous spread</p> Signup and view all the answers

    Why are girls more prone to UTIs after the age of 12 months?

    <p>Because of their shorter urethra</p> Signup and view all the answers

    What is the recommended dose of nitrofurantoin for treating UTIs?

    <p>5-7 mg/kg/24 hr in 3-4 divided doses</p> Signup and view all the answers

    What is the significance of microscopic hematuria in acute cystitis?

    <p>It is a common finding, but alone does not suggest UTI</p> Signup and view all the answers

    Why is amoxicillin not a preferred initial treatment for UTIs?

    <p>It has a high rate of bacterial resistance</p> Signup and view all the answers

    What is the recommended duration of antibiotic treatment for acute febrile UTIs?

    <p>7-14 days</p> Signup and view all the answers

    What is a possible cause of sterile pyuria?

    <p>All of the above</p> Signup and view all the answers

    In which scenario is hospital admission and IV antibiotic therapy indicated?

    <p>Children who are dehydrated and vomiting</p> Signup and view all the answers

    What laboratory findings are characteristic of upper UTI?

    <p>Leukocytosis, increased ESR, and increased CRP</p> Signup and view all the answers

    What is the recommended dose of ceftriaxone for hospitalized children?

    <p>50 mg/kg/24 hr</p> Signup and view all the answers

    Why is it essential to draw blood cultures before starting antibiotics in pyelonephritis?

    <p>To rule out sepsis, particularly in infants and children with obstructive uropathy</p> Signup and view all the answers

    What is the advantage of using cefixime over ceftriaxone?

    <p>It is an oral medication</p> Signup and view all the answers

    What is the indication for performing a VCUG?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended age range for using oral fluoroquinolones?

    <p>Children older than 17 years</p> Signup and view all the answers

    What is the purpose of a technetium-99m DMSA scan?

    <p>To identify renal scarring as a late effect of UTI</p> Signup and view all the answers

    What is the primary prevention method for UTIs?

    <p>Promoting good perineal hygiene and managing underlying risk factors</p> Signup and view all the answers

    What is the recommended treatment duration for acute cystitis?

    <p>3-5 days</p> Signup and view all the answers

    What antibiotic is effective against many strains of E. coli?

    <p>Trimethoprim-sulfamethoxazole (TMP-SMX)</p> Signup and view all the answers

    What is the recommended approach for preventing UTI in children at high risk?

    <p>None of the above</p> Signup and view all the answers

    Which of the following urologic conditions may benefit from long-term prophylaxis?

    <p>Neuropathic bladder</p> Signup and view all the answers

    What is the definition of vesicoureteral reflux (VUR)?

    <p>Retrograde flow of urine from the bladder to the ureter or kidney</p> Signup and view all the answers

    What is the most common clinical manifestation of vesicoureteral reflux (VUR)?

    <p>Recurrent febrile UTI</p> Signup and view all the answers

    Which diagnostic study is required to confirm the diagnosis of VUR in a child with recurrent febrile UTI?

    <p>Voiding cystourethrogram (VCUG)</p> Signup and view all the answers

    What is the likelihood of resolution of grade 1 and 2 primary VUR?

    <p>High</p> Signup and view all the answers

    What is the management option for severe (grade 5) primary VUR?

    <p>All of the above</p> Signup and view all the answers

    What is the risk of recurrent febrile UTI in children with higher grade VUR?

    <p>High</p> Signup and view all the answers

    Who should be suspected of having a UTI?

    <p>All infants and young children with unexplained fever and patients of all ages with fever and congenital anomalies of the urinary tract</p> Signup and view all the answers

    What is necessary for confirmation of diagnosis and appropriate therapy?

    <p>Urine culture</p> Signup and view all the answers

    How is a urine sample obtained in toilet-trained children?

    <p>Midstream urine sample</p> Signup and view all the answers

    What indicates infection in older children and adolescents?

    <p>More than 100,000 CFU/mL of a single pathogenic organism</p> Signup and view all the answers

    What is not recommended for urine collection for culture?

    <p>Perineal bags</p> Signup and view all the answers

    What suggests infection but is not diagnostic?

    <p>Pyuria</p> Signup and view all the answers

    How is a urine sample obtained in children who are not toilet-trained?

    <p>Catheterized or suprapubic aspirate urine sample</p> Signup and view all the answers

    What are usually positive in infected urine?

    <p>Nitrites and leukocyte esterase</p> Signup and view all the answers

    Study Notes

    Epidemiology

    • Approximately 3% of girls and 1% of boys have a UTI during their prepubertal years.
    • The highest incidence of UTI is in the first year of life, with uncircumcised boys being at a 10-fold greater risk of developing a UTI compared to circumcised boys during this period.
    • After 12 months of age, UTI in healthy children is usually seen in girls (short urethra predisposes girls to UTIs).

    Etiology

    • UTIs are caused primarily by colonic bacteria.
    • Escherichia coli causes 54-67% of all UTIs, followed by Klebsiella spp. and Proteus spp., Enterococcus, and Pseudomonas.
    • Other bacteria known to cause UTIs include Staphylococcus saprophyticus, group B streptococcus, and, less commonly, Staphylococcus aureus, Candida spp., and Salmonella spp.

    Pathogenesis and Pathology

    • Nearly all UTIs are ascending infections.
    • Bacteria arise from the fecal flora, colonize the perineum, and enter the bladder via the urethra.
    • In uncircumcised males, bacterial pathogens arise from the flora beneath the prepuce.
    • Bacteria causing cystitis can ascend to the kidney to cause pyelonephritis.
    • Rarely, renal infection occurs by hematogenous spread, as in endocarditis or in some bacteremia neonates.
    • Children of any age with a febrile UTI can have acute pyelonephritis and subsequent renal scarring, but the risk is highest in those younger than 2 years of age.

    Diagnosis

    • UTIs may be suspected based on symptoms or findings on urinalysis, or both.
    • Urinalysis (GUE) and urine culture are necessary for confirmation of diagnosis and appropriate therapy.
    • Imaging studies (e.g., ultrasound of the bladder and kidney, VCUG, and technetium-99m dimercaptosuccinic acid (DMSA) scan) are used to identify anatomical abnormalities and detect hydronephrosis.

    Treatment

    • Acute cystitis should be treated promptly to prevent possible progression to pyelonephritis.
    • A 3- to 5-day course of therapy with trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin, or amoxicillin is effective against many strains of E. coli.
    • In acute febrile UTIs, a course of antibiotics for 7-14 days is required.
    • Hospital admission and intravenous (IV) rehydration and IV antibiotic therapy are indicated for children who are dehydrated, vomiting, unable to drink fluids, or those with complicated infections or urosepsis.

    Prevention

    • Primary prevention is achieved by promoting good perineal hygiene and managing underlying risk factors for UTI, such as chronic constipation and daytime and nighttime urinary incontinence.
    • Urologic conditions for recurrent UTIs that might benefit from long-term prophylaxis include neuropathic bladder, urinary stasis and obstruction, urinary calculi, and severe vesicoureteral reflux.
    • Antimicrobial prophylaxis using trimethoprim or nitrofurantoin at 30% of the normal therapeutic dose once a day can be effective.

    Vesico Ureteral Reflux

    • Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder to the ureter or kidney.
    • VUR is the most common anatomic abnormality found in infants and young children with febrile UTI.
    • There is a genetic predisposition to primary VUR with an increased risk in children with affected parents or siblings.
    • Secondary VUR may be present in children with other urinary tract anomalies.
    • Clinical manifestations of VUR include febrile UTI, recurrent febrile UTI, and asymptomatic presentations.
    • Diagnostic studies for VUR include renal ultrasound and voiding cystourethrogram (VCUG).
    • Management options for a child with VUR include surveillance, medical therapy, and surgical intervention.

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    Description

    Learn about the epidemiology, etiology, pathology, risk factors, clinical manifestations, investigations, complications, and treatment of Urinary Tract Infections (UTIs) in this 5th-grade lecture.

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