Urinary tract infection
>>Common pathogens
▫E. coli (80-90%)
▫Klebsiella pneumoniae
▫Other enteric gram –ve’s (Proteus spp., Enterobacter spp., Citrobacter spp., Pseudomonoas aeruginosa)
▫Enterococcus faecalis, E. faecium

Febrile urinary tract infection - Diagnosis
>>Sterile urine specimen is essential
▫Suprapubic aspiration
▫Transurethral catheterization
▫Clean catch
>>Bag specimens are notoriously unreliable
▫Good negative predictive value (can rule out UTI)
▫High false positive rate (85%) - get cleaner urine (catheter) if +ve, don't send bag for culture
>>Presumptive diagnosis (urinalysis, microscopy)
▫Microscopy (presence of bacteria, WBC)
▫Urinalysis (leukocyte esterase, nitrites)

Radiologic investigations
>>Renal and bladder ultrasound recommended after first UTI in all children to check for structural abnormalities

Management
>>Complicated UTI (criteria for admission)
▫Acutely ill, young (< 2-3 mo.), vomiting, immunocompromised
▫Admit for hydration, IV antibiotics
▫Ampicillin plus gentamicin
>>Uncomplicated UTI (kids that go home)
▫Well child
▫Oral antibiotic therapy (options include amoxicillin-clavulanate, cephalexin, TMP-SMX, cefixime…)
>>Antibiotic therapy should be given for 7-10 days