1. In the neonatal age group, boys with UTIs outnumber girls
2. Figueroa, E.T. (2011, April). Urinary Tract Infections . KidsHealth - the Web's most visited site about children's health. Retrieved September 16, 2011, from http://kidshealth.org/teen/diseases
3. Patient status comparison
4. Gold standard of each component
5. Supplemental video
6. Connecting 2 similiar pathologies
7. Sometimes UTIs can be self limiting in the bladder with doses of an antibiotic regimen
   1. they can occassionally be severe
   2. the infection can spread from the bladder up the ureters to the kidneys and eventually into the blood stream
      1. sepsis - illness where blood stream is overwhelmed by bacteria
   3. There will be a decrease in blood pressure, depriving major organs of oxygen and respiratory support to keep the lungs functioning
   4. urosepsis - symptoms of sepsis originating from a urinary source
      1. http://youtu.be/lIakMEHk8QU
      2. Patient may have had urinary symptoms untreated for some time, resulting in the urosepsis manifesting as a fever
8. Causes
   1. E.Coli and other gram-negative enteric organism
   2. Proteus, Pseudomonas, Klebsiella, Staphylococcus aureus, Haemophilus, and coagulase-negative staphylococci
   3. presence or absence of foreskin on males and structure of lower urinary tract in females
   4. urinary stasis
   5. Patient is uncircumcised and stool sample positive for E.coli
9. Pathophysiology
   1. After invasion, the first line of defense is complete evacuation by voiding
   2. Inflammation in the bladder and urethral walls is apparent within 30 min of invasion
   3. Leukocytes rapidly migrate to the bladder wall within 2 hrs
   4. Proliferation of the bacteria that remains on the thin film of urine that closely adheres to the bladder wall
10. Clinical Manifestations
    1. may be symptomatic or asymptomatic
    2. signs are characteristically nonspecific
    3. more nearly resemble GI tract disorders
       1. failure to thrive
       2. feeding problems
       3. vomiting
       4. diarrhea
       5. abdominal distention
       6. jaundice
    4. may have fever, hypothermia or sepsis
    5. frequent or infrequent voiding, strong smelling urine and abnormal stream
    6. constant squirming and irritability
    7. Patient is irritable and presented with a fever upon admission
11. Diagnostics
    1. history and physical exam
    2. urinalysis and culture
    3. urine:cloudy, hazy, or thick with noticeable strands of mucus and pus
       1. smells fishy and unpleasant even when fresh
    4. microscopic exam of urine reveal pyuria
       1. 5-8 WBC/ml of uncentrifuged urine
    5. presence of at least one bacterium in Gram stain
    6. Urine and blood culture positive for bacteria
12. Therapeutic Management
    1. antibiotic therapy
       1. depends on lab culture and sensitivity tests
       2. given appropriate type IV for at least 48 hrs
    2. blood and urine culture obtained on admission and after therapy
       1. urine cultures repeated monthly for 3 mo and at 3 mo interval for another 6 mo
    3. radiologic evaluation if first UTI
    4. anatomic defects may require surgical correction
    5. follow-up study
    6. Cefotaxime antibiotic infusion every 6 hrs
13. Nursing Care Management
    1. education on prevention and treatment of infection
       1. signs of UTI: incontinence in toilet-trained child, strong-smelling urine, frequency or urgency
    2. obtain acceptable, clean-voided specimens
    3. encourage adequate clear fluid intake
    4. Mother received education
       1. disease and infection transmission
       2. infection control
       3. disease process and management