儿童泌尿道感染及其治疗-(英文PPT)UTI-in-Children课件

UTI IN CHILDREN2007UTI in Children2007Risk factors for UTIPoor urine flowPrevious proved or suspected UTIRecurrent fever of unknown originAntenatally diagnosed renal abnormalityFamily history of vesico-ureteric refluxconstipationRisk factors for UTIPoor urineRisk factors for UTIDysfunctional voidingEnlarged bladderAbdominal massEvidence of spinal lesionPoor growth high blood pressureRisk factors for UTIDysfunctioUrine samplingA clean catch sample should be obtainedIf not possibleUse non invasive method i.e.Urine collection padDo not use cotton wool balls,gauze or sanitary towels.If non invasive method not possibleUse catheter sample or suprapubic aspirationUrine samplingA clean catch saSymptoms and signsAge 3/12Most commonFever,vomiting,lethargy,irritabilityLess commonPoor feeding,failure to thriveLeast commonAbdominal pain,jaundice,haematuria,offensive urine.Symptoms and signsAge 3/12 preverbalMost commonFeverLess commonAbdominal pain,loin tenderness,vomiting,poor feeding.Least commonLethargy,irritability,haematuria,offensive urine,failure to thrive.Symptoms and signsAge 3/12 pSymptoms and signsAge 3/12 verbalMost commonFrequency,dysuriaLess commonDysfunctional voiding,changes to continence.Abdominal pain,loin tenderness.Least commonFever,malaise,vomiting,haematuria,offensive urine,cloudy urineSymptoms and signsAge 3/12 vMicroscopy resultsPyuria positivePyuria negativeBacteria positiveTreat as though has UTITreat as though has UTIBacteria negativeAntibiotic treatment to start if clinically has UTITreat as though does not have UTIMicroscopy resultsPyuria positManagement 3/12Refer to paediatriciansManagement 3/12 3/12 3/12 3/12 3/12 3/12 3/12 3/12 3 MonthsWith acute pyelonephritis/upper UTIConsider referral to paediatriciansTreat with oral antibiotics for 7-10 days(cephalosporin or co-amoxiclav)If oral antibiotics not suitable give IV(cefatoxime or ceftriaxone)for 2-4 days then orallyAge 3 MonthsWith acute pyeloAge 3 monthsWith cystitis/lower UTITreat with oral antibiotics for 3 days choice depending on local resistance patternsParents should be advised if child still unwell after 24-48hrs to bring back for reassessmentIf no alternative diagnosis made a urine sample should be sent for culture.Prophylactic antibiotics should not routinely be given in children following first time UTI.Imaging should be carried out as per guidelinesAge 3 monthsWith cystitis/loIndications for cultureDiagnosis of acute pyelonephritis/upperUTIHigh or intermediate risk of serious illnessSingle positive result on dipstick testing Recurrent UTIInfection that does not respond to treatment in 24-48hrsClinical symptoms and dipstick testing dont correlateIndications for cultureDiagnosLocalising site of infectionAcute pyelonephritis/upperUTIBacteriuria and fever 38C or higherBacteriuria,loin pain/tenderness and fever less than 38CCystitis/lowerUTIBacteriuria but no systemic featuresLocalising site of infectionAcPreventing recurrenceAddress dysfunctional voiding syndromesManage constipationEncourage children to drink adequate amountsAdvise not to delay voidingPreventing recurrenceAddress dImagingAge 6/12Responded to treatment within 48hrsUltrasound at 6/52Atypical UTI and recurrent UTIUltrasound during acute infection,DMSA 4-6/12 after infectionMCUGImagingAge 6/12 but 6/12 but 3yrsImagingAge 3yrs or olderResponds well to antibiotics within 48hrsNo imaging requiredAtypical UTIUltrasound during acute infectionRecurrent UTIUltrasound within 6/52DMSA at 4-6 monthsImagingAge 3yrs or olderReferral and assessmentThose who have recurrent UTI or abnormal imaging results should be assessed by paediatric specialistThose who do not require imaging do not need specialist assessmentAssymptomatic bacteriuria does not require follow upReferral and assessmentThose w儿童泌尿道感染及其治疗-(英文PPT)UTI-in-Children课件