UTI and Pyelonephritis (2 mo - 24 months)



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UTI and Pyelonephritis (2 mo - 24 months)

Consider pediatric consult

Consider other source

Suprapubic tenderness alone OR 2 or more risk factors:

  • White race
  • Age < 12 months
  • Temperature > 39 C (102.2 F)
  • Fever > 24 hours
  • No apparent source
  • History of UTI

Pyuria present on urine dip?

Consider other source

Urinalysis with micro, Urine
Urine Culture, Urine

Well appearing?

Consider other source OR wait for culture with PMD in 24 hours

Discharge criteria

  • Reassuring vital signs
  • Tolerating PO
  • Well-appearing
  • No social/family concerns
  • Reliable follow up in 24 hours
  • Parents comfortable and understand discharge plan
  • Provider comfortable with outpatient therapy

Urine bag already placed?

History of UTI?

Contraindications to probiotics?

Probiotics

Meets discharge criteria?

Cephalosporin allergy?

Female?

Cephalexin 25 mg/kg PO 4 times a day x7 days, PMD followup within 24 hours

Cephalosporin allergy?

Ceftriaxone injection
Admit to Floor

Infectious disease consult

Admit to Floor
Gentamicin injection

Consider historical cultures, consider urology or ID consult

Bactrim 6 mg(TMP)/kg PO BID x7 days, PMD followup within 24 hours

Clinical concern for UTI

  • Non-toilet trained children
  • Fever without a source
  • Suprapubic tenderness
  • Abdominal pain
  • Jaundice
  • Frequent unexplained vomiting
  • Dysuria, urgency, frequency
  • Back pain

Two-step urine collection process (if implemented in the care center)

4 minimal criteria for urine bag to be placed on patient arrival

#

Females

Males

1

Temperature elevation (°C)

≥38.5

2

Temperature duration (hours)

≥48

3

Age(years)

<2

Uncircumcised <2

Circumcised <1

4

History of UTI symptoms concerning for UTI

Any


Exclusion from urine bag

  • < 6 months
  • Moderate to severe dehydration
  • Potty trained

Presumed UTI on UA?

Inclusion Criteria
  • Fever > 38.0 C (100.4 F) x1 at home, OSH or in ED
  • Clinical concern for UTI
Exclusion Criteria
  • Toilet trained
  • Toxic appearance
  • Immunosuppresed, cancer
  • Previous GU surgery or anatomical abnormality (VUR, etc.)
  • Chronic kidney disease
  • Recent history of sexual abuse
  • Other pmhx or complicating factor (nephrolitiasis, etc)

Suprapubic tenderness alone OR meets criteria based on risk factors

(2 risk factors for uncircumcised, 3 risk factors for circumcised)

  • Nonblack race
  • Temperature > 39C
  • Fever > 24 hours
  • No apparent source
  • History of UTI

Urine test Interpretation

Presumed UTI (UA Pyuria)

  • Positive nitrite or leukocyte esterase and microscopy showing bacteria or > 10 WBC / hpf

Definitive UTI (Urine culture)

  • Urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following:
  • Suprapubic aspiration: > 1,000 cfus
  • Catheter sample: > 50,000 cfus (often reported as 10-50,000 cfus depending on lab)
  • Clean catch sample: > 100,000 cfus

Consider other source OR treat empirically for UTI




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