Pediatric Guidelines: Urinary Tract Infections - Hospital Onset

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Diagnosis of UTI in most patients requires positive urinalysis and culture with compatible urinary tract symptoms

Asymptomatic bacteriuria is common in hospitalized patients and in most cases should not be treated. 

Ensure appropriate collection methods (catheterization or clean catch). 

Therapy should be modified according to culture and susceptibilities. 

For patients with prior UTIs, consider prior causative organisms when selecting empiric therapy. 

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Urinary tract infection, hospital-onset

This category is intended for catheter-associated infection, or patients with significant prior antibiotic exposure - for patients at low-risk for drug-resistant organisms, refer to Community-Onset UTI section

Enteric and hospital-acquired Gram negatives including Pseudomonas aeruginosa

 

Enterococcus spp and Candida spp are more likely to represent colonization than true infection

Ceftazidime 50mg/kg/dose IV q8h (max 2g/dose)

Non-severe cephalosporin allergy:

Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)

Duration: 7-14 days based on severity

Modify therapy based on culture and susceptibility of isolated organism

Severe beta lactam allergy:

Ciprofloxacin 15mg/kg/dose IV/PO q12h (max 400mg/dose IV, 500mg/dose PO)

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).