1 / 20

Guidelines for Childhood UTI Management and Prevention

Detailed guidelines for the consistent strategy, investigation, and future prevention of urinary tract infections (UTI) in children, including symptoms, urine collection protocol, treatment, history assessment, and prevention advice. The guidelines cover urine collection protocols, treatment options, and referral criteria for UTI in children efficiently and thoroughly.

berne
Download Presentation

Guidelines for Childhood UTI Management and Prevention

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DCH GUIDELINES FOR CHILDHOOD UTI(Informed by NICE) ROLLO CLIFFORD 2008

  2. PURPOSE • Consitent strategy for: • Management • Investigation • Future prevention • Further follow up

  3. DCH • aims to select out children for detailed investigation and follow up whilst causing the least disruption to the lives of those at lowest risk.

  4. Suspecting UTI in Infants • Reduced feeding or Vomits more than usual. • Fever with no other obvious explanation. • Sleepy and lethargic • Stops gaining weight or unexpected loss. • Has jaundice which gets worse when more than a week old. • (Unusual smell to urine) • (Seems to be in pain at times and when urine is passed)

  5. Urine Collection ProtocolMessages for Primary Care • MSU, CCU, Pad OK – Bag not. • Stick test can exclude if negative to both nitrites and leucocytes. • But send to lab anyway and consider treatment if: • Under 3 years • Symptoms highly suggestive. • If positive to either send + consider treat.

  6. Treatment • Treat rapidly if upper tract features • Infants nearly always in this category • Urine sample essential – Murphy’s law! • Amoxycillin excellent – if sensitive – toss a coin? • Trimethoprim/Augmentin/Cephalexin • Hospital if unable to take or ill

  7. The History - PC, PMH, FH • Initial symptomatology – fever, vomiting, site of pain/discomfort • Method of urine collection • Previous infections • Family history - renal problems and hypertension

  8. Poos and Wees • Dysfunctional Elimination Syndrome • Urge syndrome • Staccato voiding • Fractional and incomplete voiding • Voiding postponement • Constipation Constipation and DES are both strongly associated with recurrent UTI and Reflux

  9. The History - voiding and bowels Symptoms between episodes – recurrent loin pain, enuresis, encopresis, neurological symptoms affecting lower limbs Bowel habit - constipation, dietary history. Potty training Voiding pattern – staccato voiding, postponement, vaginal reflux (legs held together during micturition) Other voiding issues – footstool for younger children, school toilets..

  10. The History – other risks • Fluid intake – too few drinks or, in some cases, interfering with appetite. • Hygiene – bubble baths, washing hair in bath, frequency, wiping, odour. • Symptoms suggestive of thread work infection.

  11. Examination • Plotted height and weight with comparison with previous centiles • Blood pressure measurement • Abdominal examination • Genital examination in pre-pubertal children (unless recorded normal elsewhere) • Urinalysis

  12. Ultrasound • Renal size • Dilation of collecting system and ureter • Bladder emptying • Congenital abnormality • Large calculi • No – ionising radiation • Atraumatic • Costs about 1/10 of an isotope scan

  13. Advice and prevention • Symptoms of infection (infants especially) • Prevention of future infection • Provide leaflet • Treat constipation – dietary advice / lifestyle / laxatives in some

  14. Ultrasound • Hopeless at picking up scarring but: • May find abnormality associated with scarring.

  15. Ultrasound • NICE – limited to: • Infants • Children with atypical or recurrent infections • Halves number of ultrasounds but may miss 2/3 of significant abnormalities. • Local protocol – continue with USS for all children. • Prospective audit?

  16. Ultrasound can: • Assess renal size • Collecting system or ureteric dilatation • Evaluate the bladder (including emptying). • Can indicate obstruction and other congenital abnormalities of the urinary tract’ • Can detect large calculi • No ionising radiation and is non-invasive • Cost – 1/10th cost of DMSA

  17. Ultrasound can not: • Exclude scarring • Exclude reflux – which may predispose to future scarring.

  18. Referral 1° to 2 ° - acute • Severe systemic upset • Inadequate fluid intake/vomiting • Infants

  19. Referral 1 ° to 2° - Letter • Any upper tract symptoms – fever >38, loin pain, vomiting, obvious systemic upset. • Two or more infections • Any abnormality on ultrasound. • Diagnostic doubt • Associated risk factors which prove difficult to manage – e.g. constipation/soiling. • GP preference

  20. Referral 1 ° to 2° - Telephone • Symptoms or ultrasound findings suggest severe obstruction (e.g. Possible urethral valves / gross renal or ureteric dilation on ultrasound – particularly if during infancy and if bilateral)

More Related