兒童泌尿道感染及其治療-(英文)UTI-in-Children課件

UTIinChildren2007UTIinChildren2007RiskfactorsforUTIPoorurineflowPreviousprovedorsuspectedUTIRecurrentfeverofunknownoriginAntenatallydiagnosedrenalabnormalityFamilyhistoryofvesico-uretericrefluxconstipationRiskfactorsforUTIPoorurineRiskfactorsforUTIDysfunctionalvoidingEnlargedbladderAbdominalmassEvidenceofspinallesionPoorgrowthhighbloodpressureRiskfactorsforUTIDysfunctioUrinesamplingAcleancatchsampleshouldbeobtainedIfnotpossibleUsenoninvasivemethodi.e.UrinecollectionpadDonotusecottonwoolballs,gauzeorsanitarytowels.IfnoninvasivemethodnotpossibleUsecathetersampleorsuprapubicaspirationUrinesamplingAcleancatchsaSymptomsandsignsAge<3/12MostcommonFever,vomiting,lethargy,irritabilityLesscommonPoorfeeding,failuretothriveLeastcommonAbdominalpain,jaundice,haematuria,offensiveurine.SymptomsandsignsAge<3/12SymptomsandsignsAge>3/12preverbalMostcommonFeverLesscommonAbdominalpain,lointenderness,vomiting,poorfeeding.LeastcommonLethargy,irritability,haematuria,offensiveurine,failuretothrive.SymptomsandsignsAge>3/12pSymptomsandsignsAge>3/12verbalMostcommonFrequency,dysuriaLesscommonDysfunctionalvoiding,changestocontinence.Abdominalpain,lointenderness.LeastcommonFever,malaise,vomiting,haematuria,offensiveurine,cloudyurineSymptomsandsignsAge>3/12vMicroscopyresultsPyuriapositivePyurianegativeBacteriapositiveTreatasthoughhasUTITreatasthoughhasUTIBacterianegativeAntibiotictreatmenttostartifclinicallyhasUTITreatasthoughdoesnothaveUTIMicroscopyresultsPyuriapositManagement<3/12RefertopaediatriciansManagement<3/12ManagementAge>3/12<3yrsSpecificurinarysymptomsUrineforurgentc&sStartantibiotictreatmentManagementAge>3/12<3yrsManagementAge>3/12<3yrsNonspecificsymptomshighriskofseriousillnessUrgentreferraltopaedsUrineforc&sManageinlinewithguidelinesforfeverishillnessinchildrenManagementAge>3/12<3yrsManagementAge>3/12<3yrsnonspecificsymptomsIntermediateriskofseriousillnessConsiderurgentreferralpaedsIfreferralnotrequiredUrgenturinec&sStartantibioticsifurinepositiveIfnotavailabledodipsticktestingIfnitritespresentstartantibioticsSendsampleforc&sManagementAge>3/12<3yrsnoManagementAge>3/12<3yrslowriskofseriousillnessUrinesampleofc&sStartantibioticsifpositiveManagementAge>3/12<3yrsloManagementChildren3yrsorolderusedipsticktodiagnoseUTILeucocyteesteraseandnitritepositiveStarttreatmentforutisendsampleforc&sLeucocyteesterasenegativenitritepositiveonfreshsampleStartantibiotictreatmentsendsampleforc&sManagementChildren3yrsoroldManagementChildren3yrsorolderLeucocyteesterasepositive,nitritenegativeSendurinesampleforc&sOnlystartantibioticsifhasuticlinicallyBothleucocyteesteraseandnitritenegativeExploreothercausesofillnessDonotstartantibioticsforutiOnlysendurinesampleifrecommendedin“indicationsforculture”ManagementChildren3yrsorolAge>3MonthsWithacutepyelonephritis/upperUTIConsiderreferraltopaediatriciansTreatwithoralantibioticsfor7-10days(cephalosporinorco-amoxiclav)IforalantibioticsnotsuitablegiveIV(cefatoximeorceftriaxone)for2-4daysthenorallyAge>3MonthsWithacutepyeloAge>3monthsWithcystitis/lowerUTITreatwithoralantibioticsfor3dayschoicedependingonlocalresistancepatternsParentsshouldbeadvisedifchildstillunwellafter24-48hrstobringbackforreassessmentIfnoalternativediagnosismadeaurinesampleshouldbesentforculture.ProphylacticantibioticsshouldnotroutinelybegiveninchildrenfollowingfirsttimeUTI.ImagingshouldbecarriedoutasperguidelinesAge>3monthsWithcystitis/loIndicationsforcultureDiagnosisofacutepyelonephritis/upperUTIHighorintermediateriskofseriousillnessSinglepositiveresultondipsticktestingRecurrentUTIInfectionthatdoesnotrespondtotreatmentin24-48hrsClinicalsymptomsanddipsticktestingdon’tcorrelateIndicationsforcultureDiagnosLocalisingsiteofinfectionAcutepyelonephritis/upperUTIBacteriuriaandfever38’CorhigherBacteriuria,loinpain/tendernessandfeverlessthan38’CCystitis/lowerUTIBacteriuriabutnosystemicfeaturesLocalisingsiteofinfectionAcPreventingrecurrenceAddressdysfunctionalvoidingsyndromesManageconstipationEncouragechildrentodrinkadequateamountsAdvisenottodelayvoidingPreventingrecurrenceAddressdImagingAge<6/12Respondedtotreatmentwithin48hrsUltrasoundat6/52AtypicalUTIandrecurrentUTIUltrasoundduringacuteinfection,DMSA4-6/12afterinfectionMCUGImagingAge<6/12ImagingAge>6/12but<3yrsRespondedtotreatmentin48hrsNoimagingrequiredAtypicalUTIUltrasoundduringacuteinfectionDMSAat4-6/12RecurrentUTIUltrasoundwithin6/52ofinfectionDMSAat4-6/12ImagingAge>6/12but<3yrsImagingAge3yrsorolderRespondswelltoantibioticswithin48hrsNoimagingrequiredAtypicalUTIUltrasoundduringacuteinfectionRecurrentUTIUltrasoundwithin6/52DMSAat4-6monthsImagingAge3yrsorolderReferralandassessmentThose