儿童泌尿道感染及其治疗-(英文)UTI-in-Children.ppt

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,UTI in Children,2007,Risk factors for UTI,Poor urine flow,Previous proved or suspected UTI,Recurrent fever of unknown origin,Antenatally diagnosed renal abnormality,Family history of vesico-ureteric reflux,constipation,Risk factors for UTI,Dysfunctional voiding,Enlarged bladder,Abdominal mass,Evidence of spinal lesion,Poor growth high blood pressure,Urine sampling,A clean catch sample should be obtained,If not possible,Use non invasive method i.e.Urine collection pad,Do not use cotton wool balls,gauze or sanitary towels.,If non invasive method not possible,Use catheter sample or suprapubic aspiration,Symptoms and signs,Age 3/12 preverbal,Most common,Fever,Less common,Abdominal pain,loin tenderness,vomiting,poor feeding.,Least common,Lethargy,irritability,haematuria,offensive urine,failure to thrive.,Symptoms and signs,Age 3/12 verbal,Most common,Frequency,dysuria,Less common,Dysfunctional voiding,changes to continence.Abdominal pain,loin tenderness.,Least common,Fever,malaise,vomiting,haematuria,offensive urine,cloudy urine,Microscopy results,Pyuria positive,Pyuria negative,Bacteria positive,Treat as though has UTI,Treat as though has UTI,Bacteria negative,Antibiotic treatment to start if clinically has UTI,Treat as though does not have UTI,Management,Age 3/12 3/12 3/12 3 Months,With acute pyelonephritis/upper UTI,Consider referral to paediatricians,Treat 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 orally,Indications for culture,Diagnosis of acute pyelonephritis/upperUTI,High or intermediate risk of serious illness,Single positive result on dipstick testing,Recurrent UTI,Infection that does not respond to treatment in 24-48hrs,Clinical symptoms and dipstick testing dont correlate,Localising site of infection,Acute pyelonephritis/upperUTI,Bacteriuria and fever 38C or higher,Bacteriuria,loin pain/tenderness and fever less than 38C,Cystitis/lowerUTI,Bacteriuria but no systemic features,Preventing recurrence,Address dysfunctional voiding syndromes,Manage constipation,Encourage children to drink adequate amounts,Advise not to delay voiding,Imaging,Age 6/12 but 3yrs,Responded to treatment in 48hrs,No imaging required,Atypical UTI,Ultrasound during acute infection,DMSA at 4-6/12,Recurrent UTI,Ultrasound within 6/52 of infection,DMSA at 4-6/12,Referral and assessment,Those who have recurrent UTI or abnormal imaging results should be assessed by paediatric specialist,Those who do not require imaging do not need specialist assessment,Assymptomatic bacteriuria does not require follow up,