1. Pediatric UTI and RefluxBy
Brent Lee Lechner, DO
MAJ, MC, USA

2. Epidemiology Different for different ages
Neonatal 5-8 X > in males than females
Infants: F>M, 1.4% > 0.2%
4 Months, F>>M by 10 X
White > Black and Hispanic
3-6 % Febrile Infants without source
Circumcised vs Uncircumcised Males
5-20 X in uncircumcised below 12 months

3. UTI - risk factors Constipation Bubble Baths Sexual activity
Infrequent voiding
Poor hygiene
Non-circumcision
Sexual Abuse
Female

4. Pathogenesis Organisms on perineum - ascending up the urethra.
85 % E. coli adherence factor
Bacteremia associated with UTI.
31 % Neonatal
18 % 1-3 months
6 % 3-8 months

5. Organisms Gram Negative Gram Positive Hemorrhagic Cystitis E. Coli
Klebsiella
Proteus
Pseudomonas
H. Flu
Gram Positive
Enterbacter
Entercoccus
Staph Saprophyticus
Hemorrhagic Cystitis
Adenovirus
H. Flu

6. Signs and Symptoms Fever Dysuria Nausea and Vomiting Abdominal Pain
Flank Pain
Frequency and Urgency

7. Signs and Symptoms in Infants
Irritability - 80%
Vomiting - 40%
Diarrhea - 30%
Poor feeding -65%
FTT
Lethargy

8. DDx Chemical Irritant Vaginitis Viral Infection Urethritis
Pyelonephritis
Glomerulonephritis
Appendicitis
Diabetes
STD
Diabetes Insipidus
Bacteremia

9. Lab Studies Urinalysis Nitrate (+) and LE (+)
WBCs - greater than 5 on hpf
Unspun urine - Any Bacteria then positive.
UA noted to be negative on % of positive cultures.

10. Urine Culture Suprapubic Tap Urine Cath. Urine Clean Catch Bag Urine
Any Growth - Positive
Urine Cath.
Greater than 100,000 colonies of a single organism
Urine Clean Catch
Greater then 100,000 colonies
If two CC, increase by 80-90%
Bag Urine
Worthless

11. Treatment
Antibiotic
Cephalosporin (third generation without sensitivity): Rocephin, Fortaz
PO: Vantin, Suprax
Bactrim
Amoxicillin
Pediatrics - No keflex.

12. Management Adult - 3-5 days Children -- 7-10 days Infants
Under 3 months (admission)
po intolerance (admission)
12 months ? Admission

13. Management Renal Ultrasound VCUG DMSA All Patients Look at Anatomy
Look for Hydronephrosis
Perirenal abscess
VCUG
Shows reflux
Must have clean urine to obtain
4-6 weeks out
DMSA
Gold standard for pyelo and scarring

14. Urinary Reflux Grade I - Reflux in Ureter
Grade II - Reflux to the Upper Collecting System, No dilation
Grade III - Reflux into dilated ureter and/or blunted calyces
Grade IV - Grossly dilated ureter
Grade V - Tortuosity

15. Urinary Reflux
VUR prophylaxis until Free of reflux for 1 year by VCUG.
Prophylaxis medications: bactrim or macrodantin
Grade III- IV need Surgery
Grade II - please refer to Urology
Consider screening siblings.