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Urinary Tract Infections, Pediatric, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Bacteria colonize via retrograde contamination of rectal or perineal flora:

    • Infants—often hematogenous spread

    • Older children—vesicoureteral reflux (VUR) major risk

  • UTI is defined by cul...

Diagnosis

UTIs in children may be difficult to diagnose without lab confirmation. 

Signs and Symptoms

History

  • Often nonspecific

  • Neonates:

    • Manifestations of sepsis

    • Feeding difficulties

    • Irritability, listlessn...

Treatment

Initial Stabilization/Therapy

  • Treat infants <3 mo old presumptively for sepsis if febrile and/or toxic until blood and other appropriate cultures are final.

  • Airway intervention for septic/a...

Follow-Up

Disposition

Admission Criteria

  • Infants <3 mo

  • Dehydration

  • Ill appearance/toxicity/sepsis

  • Suspected pyelonephritis

  • Urinary obstruction

  • Vomiting, inability to retain medications

  • Failure to respond t...

Pearls and Pitfalls

  • UTI may require lab confirmation of clinical suspicion. Signs and symptoms are often nonspecific.

  • Febrile infants with UTI may be bacteremic.

  • Neonates with UTI may have normal urinal...

Additional Reading

  • American Academy of Pediatrics, Subcommittee on Urinary Tract Infection. Urinary tract infection: Clinical practice guidelines for the diagnosis and management of the initial UTI in...

Codes

ICD9

  • 041.49 Other and unspecified Escherichia coli [E. coli]

  • 593.70 Vesicoureteral reflux unspecified or without reflux nephropathy

  • 599.0 Urinary tract infection, site not specified

  • 041.3 Klebsiella...

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