📋 Stepwise Approach to Pediatric UTI
🔑 Key Principles — Nelson Ch 575
• Prevalence: 7% of febrile infants <24mo; uncircumcised males highest risk.
• Etiology: E. coli (80%), Klebsiella, Proteus, Enterococcus.
• Diagnosis: Urinalysis (leukocyte esterase, nitrite, microscopy) + culture ≥50,000 CFU/mL. Catheter specimen gold standard in non-toilet-trained.
• Pyelonephritis vs cystitis: Fever, flank pain, ill appearance → renal involvement; risk of scarring.
• Imaging: Renal/bladder US for children 2-24mo with first febrile UTI; VCUG if abnormal US, atypical features, or recurrent UTI (NICE/AAP).
• Treatment: Oral antibiotics (cephalexin, cefixime) for uncomplicated; parenteral (ceftriaxone) if ill/dehydrated. Duration: cystitis 3-5d, pyelonephritis 7-10d.