Tasty Morsels of EM 093 – #FRCEM Paediatric UTI

29 Jul

(Featured Image: Bobjgalindo on Wikimedia Commons, CC License)

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

From the NICE 2007 guidance on the subject (of note this is due for change this year or next i think so keep your eyes peeled…). This was not a simple and easy to summarise guideline and the mess of notes below reflect the detail contained within it. There is an RCEM summary too.

How should the urine be collected?

  • clean catch preferred
  • failing that pads
  • failing that supra pubic

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When should you consider UTI?

  • usual symptoms
  • antenatal renal issue
  • Fhx VUR
  • constipation
  • spinal lesion
  • high BP

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What testing do you need to do to confirm UTI?

  • this is complicated and worth reading yourself
  • from what  i can gather
    • under 3 months be guided by microscopy primarily
    • 3 months to 3 years microscopy is preferred and disptick only if microscopy not available and only in the intermediate risk group (told you it was complicated…)
    • over 3 years it’s much simpler and dispstick considered as useful as microscopy so just use a dipstick.
    • assumes you’re culturing everyone

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Indications for culture?

  • pyelo
  • “high to intermediate risk of serious illness”
  • under 3 years
  • +ve for leucs or nitrites
  • recurrent UTI
  • when symptoms and dipstick don’t correlate

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What is an atypical UTI?

  • “seriously ill”
  • poor flow
  • abdo/bladder mass
  • raised creatinine
  • septicaemia (presumably they mean +ve blood cultures?)
  • non e coli
  • no response in 24 hrs

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How should we manage UTI?

  • under 3 months
    • IVs and admit
  • over 3 months with pyelo (which means fever effectively)
    • orals are fine even in pyelo if suitable
    • 7-10 days as length of course
  • over 3 months with cystitis
    • 3 days orally
  • no routine antibiotic prophylaxis

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Name some bugs in UTI?

  • E Coli
  • Klebsiella
  • Enterobacter
  • Proteus
  • Yersinia enterocolitica

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Who needs imaging?

  • i tried to neatly summarise but i really couldn’t and gave up… soz…

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One Reply to “Tasty Morsels of EM 093 – #FRCEM Paediatric UTI”

  1. Pingback: Tasty Morsels of EM 093 – #FRCEM Paediatric UTI – Global Intensive Care

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