December Week 3: Urinary Tract Infections
Article:
Case:
You are in the VHC ED seeing an 11mo ex-FT female with history of one prior UTI at 5 mo of age presenting with fever to 101. Mom notes she has been increasingly fussy and has been breastfeeding less often today. She also had one episode of NBNB emesis this morning. Per Mom she has had no URI symptoms or diarrhea. There are no sick contacts in the home but she does attend daycare.
On exam the child is intermittently fussy but consolable. She appears mildly dehydrated. Head and neck exam is non-focal. On heart and lung exam she is tachycardic but the exam is otherwise benign. Abdomen is soft and non-distended with normoactive BS.
1. What is the prevalence of UTI among febrile infant girls vs febrile infant boys?
2. What are the individual risk factors in boys and in girls used to determine low vs high likelihood of UTI?
3. What are the criteria in the 2011 AAP guidelines needed to establish a diagnosis of UTI?
4. Why are urinary nitrites not a sensitive marker for UTI in children?
5. Why is leukocyte esterase not a specific marker of UTI?
6. What is the ideal length of antimicrobial therapy in infants and children 2-24mo with established UTI?
7. Why should Nitrofurantoin and other drugs metabolized in a similar way not be used to treat febrile infants with UTI?
8. When is RBUS (Renal and Bladder US) recommended?
9. When is VCUG recommended? Would VCUG be appropriate in this child?