Jodi is a 2 year old girl with fever who presents to your rural emergency department. Jodi's mother reports that she has been recently fatigued and complaining of non-specific abdominal pain.
SNAP SAMP:
List TWO risk factors that increase UTI in children.
What are THREE common organisms in UTI?
Name TWO potential complications of UTI.
How do you obtain a urine sample from this 2 year old girl?
What are THREE steps in your management of this child?
Answers:
1)
Posterior urethral valves
Vesicoureteral reflux
Recent instrumentation
Constipation
2) KEEPS mnemonic:
K - Klebsiella
E - Enterococcus
E - E. Coli (80%)
P - Proteus
S - Staph (15%)
3)
Pylenonephritis
Acute renal failure
Sepsis
Abscess
4) Discussion with parents about bag sample vs. clean catch catheterization. Catheterization is the preferred method as it can reliably diagnose a UTI. However, it may cause discomfort to the patient and parents. A bag sample may be attempted but it is only helpful if the bag sample is negative. A positive sample may reflect contaminate and a new sample should be obtained by catheterization.
Consider getting a midstream urine by Bladder Stimulation Technique - a novel approach at obtaining a non-invasive urine sample:
5)
Antibiotics - 7-10 day course in children, choices include:
Trimethroprim-sulfamethoxazole
Nitrofurantoin
Cephalexin
Amoxicillin
Tylenol or Advil for antipyretic and analgesia
Renal bladder ultrasound
In children, this is done for all UTI less than 2 years old
Additionally, this should be done for 1st UTI in boys, or recurrent UTI in girls, or children with poor growth