1 / 18

Morning Report

Morning Report. August 3, 2010. UTIs. Lower Bladder Urethra Upper Kidneys Renal pelvis Ureters. Risk Factors. Age Infants Teenagers Sex First 3 postnatal months Males First 6 years Females. Risk Factors. Previous history Sibling with UTI Catheterization

fisseha
Download Presentation

Morning Report

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. Morning Report August 3, 2010

  2. UTIs • Lower • Bladder • Urethra • Upper • Kidneys • Renal pelvis • Ureters

  3. Risk Factors • Age • Infants • Teenagers • Sex • First 3 postnatal months • Males • First 6 years • Females

  4. Risk Factors • Previous history • Sibling with UTI • Catheterization • Structural Abnormalities • Most important risk factor for the development of pyelonephritis??

  5. Common Bugs • E.coli • 90% • Enterobacter • Proteus • Kebsiella

  6. Defense • Empty bladder regularly

  7. Signs and Symptoms • Older children • Fever • Chills • Nausea/Vomiting • Flank pain • Dysuria • Urgency • Frequency • Suprapubic or CVA tenderness • Younger children and infants • Fever • Irritability • Poor feeding • Lethargy • Abd pain • Vomiting • Loose stools

  8. To Bag or Not to Bag? • Bag specimen • Urethral catheterization • Suprapubic aspiration • Clean Catch • Older children

  9. Results • Leukocyte esterase • WBCs • Nitrites • Bacteria • Gram stain

  10. Results • Pyelonephritis • Elevated peripheral WBC count • ESR • CRP • None are sensitive or specific enough to include or exclude

  11. Results • Culture results • Diagnostic confirmation • Suprapubic tap • Any growth • Cath • >50,000 • Midstream Catch • >100,000

  12. Imaging • Not needed to confirm diagnosis of pyelo • U/S • CT • More sensitive • DMSA • Test of choice • Detects renal scarring • Not routinely used

  13. Treatment • Local microbial resistance patterns • Hospitalization - IV • Ampicillin and gentamicin • 1st, 2nd or 3rd generation cephalosporins • Bactrim • Penicillin/beta-lactamase inhibitor combos • IV meds until afebrile for 24 hours • Can give IM dose followed by PO for uncomplicated pyelo

  14. Treatment - PO • Amoxicillin • 40% are resistant • Bactrim • Do not use if local resistance is over 10-20% • 1st, 2nd or 3rd generation cephalosporins • Penicillin/beta-lactamase inhibitor combos • Cipro • Always tailor based on cultures • 10-14d

  15. Follow up • No f/u culture needed • < 5 years old • Antibiotics until work up complete • Renal U/S • VCUG • Older children may warrant eval if febrile UTI or pyelonephritis occurs

  16. VUR

  17. Complications • Bacteremia • Obstruction • Abscess • Recurrence • Renal Scarring • HTN

More Related