Prophylactic cefdinir for pediatric cases of complicated urinary tract infection

Background: This study evaluated the effect of prophylactic cefdinir (3 mg/kg given once daily) for the prevention of recurrent and complicated urinary tract infections (UTI) in pediatric patients. Methods: The study included 14 infants who were observed for at least 6 months following the first signs of infection (eight boys, six girls; mean age at admission [±SD]: 6.2 [±7.4] months). Twelve patients had vesico‐ureteric reflux (grade I, two; grade II, three; grade III, six; grade IV, one), and two patients had ureteropelvic junction stenosis. Results: No patients discontinued medication due to diarrhea or other adverse drug reactions. The patients had a 6‐month recurrence‐free rate of 93% (13/14); only one patient had recurrent UTI. The mean urinary cefdinir concentration was 16.3 [±11.7]µg/mL; there was considerable variability among individual measurements, even though the samples were collected at similar intervals after drug intake (mean 18.00 [±2.63] h after dose). However, the lowest measured urinary cefdinir concentration (1.16 µg/mL) was sufficient to eradicate Escherichia coli, one of the most significant causes of UTI. Fecal cultures, obtained at monthly clinic visits during the observation period, indicated that the patients' E. coli strains were very sensitive to cefdinir. No patients were infected with Pseudomonas aeruginosa or other non‐fermenting Gram‐negative bacilli or fungi. Conclusions: These results show that cefdinir given 3 mg/kg once daily is very effective and safe for preventing recurrent complicated UTI in infants.     

经脐单部位三通道腹腔镜治疗小儿上尿路疾病

目的 探讨经脐单部位三通道腹腔镜治疗小儿上尿路疾病手术的初步应用和体会.方法 2010年9月共完成3例经脐单部位三通道腹腔镜手术,包括肾盂输尿管成形术1例;重复肾重复输尿管切除术1例;乳头式输尿管膀胱再植术1例.结果 全部手术均在单部位腹腔镜下成功完成,无需术中增加套管或开放手术,无术中并发症出现,估计平均出血量小于20 ml,术中术后无输血.手术时间分别为:肾盂成形术200 min、重复肾重复输尿管切除术85 min、输尿管膀胱再植术160 min.均于术后24 h内恢复饮食,重复肾切除术后1 d拔除引流管和尿管,肾盂成形术和输尿管膀胱再植术后2 d拔除引流管,术后7 d拔除尿管.分别于术后10 d、5 d、8 d出院,肾盂成形术和输尿管膀胱再植术患儿均于术后1个月拔除双J管.术后3个月复查,肾盂成形术后患儿复查静脉尿路造影可见吻合口通畅,肾积水减轻;重复肾患儿复查彩超见残存的下肾血供良好,肾核素扫描示分肾功能好;输尿管膀胱再植术后复查静脉尿路造影及膀胱尿道造影未见吻合口狭窄和反流,脐部切口美观.结论 经脐单部位三通道腹腔镜手术用于小儿泌尿外科毁损性和功能重建性手术安全、可行、手术瘢痕小且隐蔽,美容效果好.但因手术器械通道狭小,术中器械之间有相互干扰且活动范围小,使吻合比较困难,单部位腹腔镜重建性手术需谨慎开展.

Abstract：

Objective To review our initial clinical experience of transumbilical single-port laparoscopy in infants with upper urinary tract diseases. Methods In June,2010, we performed transumbilical single-port laparoscopies in 3 patients, including 1 pyeloplasty, 1 heminephroureterectomy and 1 papillary type ureteral reimplantation. Results All cases were completed successfully. No additional trocar was used and no complications were observed. The mean blood loss was less than 20ml. The operative time was 200 min for pyeloplasty,85 min for heminephroureterectomy and 160min for papillary type ureteral reimplantation, respectively. In the pyeloplasty case, the drainage tube and ureter were removed 1 day after surgery. In the last 2 cases, the drainage tubes were removed 2 days post-operatively and urinary catheters were removed 7 days post surgery, respectively. The patients were discharged on the 10th,5th and 8th post-operative day. Double-J ureteral stents were removed 1 month after surgery in the first two patients. After 3 month follow-up, the first patient showed significant alleviation in hydronephrosis,the low pole kidney of the second patient was well and MRU did not demonstrate any reflux in the last patient. Conclusions Applying transumbilical single-port laparoscopic technique in breakage and reconstruct surgery is safe and feasible, with the advantages of less trauma and more cosmetic benefit. However,more specific instruments are required to better apply the technique; difficulties still exist including,limited movement of instruments,suturing and knotting.     

Frequency of urinary tract infection in pediatric liver transplantation candidates

An increased frequency of infections has been reported in patients with chronic liver disease. The tendency of patients in this population to acquire UTI is not completely understood. We aimed at investigating the incidence of UTI in children with cirrhosis, before liver transplantation. Twenty-six children (9 girls, 17 boys; mean age, 7.66 +/- 5.73 yr) with chronic liver disease who had undergone liver transplantation between 2002 and 2004 were included. On admission for liver transplantation, patients were examined for presence of UTI. Serum biochemistry, complete blood cell count, urinalysis and culture, glomerular filtration rate, and abdominal ultrasonography were performed prior to liver transplantation. Ten of 26 patients (38.5%) were found to have symptomatic UTI. Urine cultures revealed E. coli in five (50%), Klebsiella pneumoniae in three (30%), Enterococcus faecalis in one (10%), and Enterobacter aeruginosa in one (10%) patient(s), respectively, as etiologic factors. The etiologies of chronic liver disease in our patients with UTI were BA in five, PFIC in three, Wilson's disease in one, and alpha-1 antitrypsin deficiency in one patient. We found a significantly greater number of UTIs in patients with biliary atresia than in those without biliary atresia (p < 0.05). The mean age of the patients with UTI was 2.75 +/- 3.49 yr, which was significantly lower than in those without UTI (9.75 +/- 4.86 yr, p < 0.05). Levels for white blood cells, thrombocytes, ALT, and alkaline phosphatase were significantly higher in patients with UTI than in those without UTI. There were no significant differences between the groups with regard to serum albumin, bilirubin, AST, GGT, BUN, or creatinine levels, glomerular filtration rate, duration of disease, and PELD scores. In patients with bacteriuria, renal USG revealed normal findings in all, but except one patient who had pelvicalyceal dilatation. Scintigraphic findings demonstrated acute pyelonephritis in six (60%) patients with UTI. VCUG demonstrated vesicoureteral reflux in two patients. In conclusion, symptomatic UTI is common in children with cirrhosis. It occurs more frequently in patients with biliary atresia than it does in patients with other types of chronic liver disease. In febrile children with chronic liver disease, UTI should be considered in the differential diagnosis.     

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目的了解小儿复杂上尿路感染的因素及致病菌的耐药现状。方法1999年1月至2004年3月在复旦大学附属儿科医院住院治疗的复杂上尿路感染患儿178例,分析其尿培养阳性的因素、致病菌分布及其对抗生素的耐药性。结果复杂上尿路感染患儿的年龄以≤1岁为主,占46.6%。致病因素中以膀胱输尿管反流为主,占61.8%,40例肾瘢痕患儿中有92.5%存在反流。复杂上尿路感染致病菌中以大肠埃希菌为主,占33%,但与单纯上尿路感染相比所占比例明显下降(P<0.001);克雷白杆菌与绿脓假单孢菌感染所占比例明显高于单纯上尿路感染所占比例(分别P<0.01,P<0.05)。产超广谱β内酰胺酶(ESBLs)菌株占革兰阴性杆菌的28%,以大肠埃希菌易产生ESBLs。革兰阴性杆菌对未加β内酰胺酶抑制剂的青霉素类及第1、2、3代头孢菌素类抗生素耐药率均高,而ESBLs菌株交叉耐药情况更为严重。结论复杂上尿路感染以婴儿期多见,膀胱输尿管反流是复杂上尿路感染及肾瘢痕的主要因素,大肠埃希菌仍是其主要致病菌,但克雷白杆菌、绿脓假单胞菌比例明显上升,致病菌耐药性高,产ESBLs菌株多重耐药严重。     

Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: An epidemiological study

ObjectiveThe aim was to determine the prevalence of voiding dysfunction and its related risk factors in Turkish schoolchildren.Materials and methodsA randomly selected, cross-sectional study was conducted using a self-administered and previously validated questionnaire. The questionnaire consisted of two parts. The first part included personal demographic and familial information, and the second part included the Dysfunctional Voiding and Incontinence Scoring System (DVISS). The questionnaires were given to 4668 children between 6 and 15 years of age, which were completed by the parents and children together. The children with a score of ≥9 were accepted as having lower urinary tract dysfunction (LUTD).ResultsThe data were collected from 4016 children (the response rate was 86.0%), including 48.6% boys and 51.4% girls. The mean age was 10.5 ± 2.2 years. The overall frequency of LUTD was 9.3%. While the 6-year-old children had the highest frequency (23.1%) of LUTD, this rate was 7.9% at the age of 10, and the children aged 14 years had the lowest frequency (4.9%), (p < 0.001). Lower urinary tract symptoms were significantly more common in girls (7.6%) than in boys (3.2%) only for the older age group (between 12 and 15 years of age). Compared with normal children, those with LUTD (with a score of ≥9) had the following risk factors: less educated parents, a parent that had lower urinary tract symptoms when he or she was a child, more persons per room (≥2 persons), more siblings (≥4 siblings) at home, past medical history of urinary tract infections, and squatting position (in girls).ConclusionsLower urinary tract problems are one of the most important and ongoing health problems in childhood. Determining the prevalence of lower urinary tract problems in children and their related risk factors is the first step to managing and reducing the number of children suffering from voiding problems.     

98例泌尿道感染患儿肾积水病因分析

目的 探讨泌尿道感染患儿肾积水的病因.方法 回顾分析2010—2020年间98例因泌尿道感染住院行泌尿系彩超发现肾盂分离患儿的临床资料.结果 98例泌尿道感染肾积水患儿基于泌尿道扩张分级系统进行分级:正常42例、1级17例、2级28例、3级11例.肾积水1、2和3级的患儿共合并泌尿系畸形36例(64.3％),发生率高于...     

Neonatal urinary tract infections: Analysis of the patients and recurrences

BACKGROUND: Early diagnosis and proper treatment, including long-term follow up, are very important for neonatal urinary tract infections (UTI). METHODS: The present study reports the analysis and long-term follow-up results of 71 newborns treated for UTI. RESULTS: Forty-one per cent of patients were preterm babies. Suspected sepsis and hyperbilirubinemia were the main presenting features. Community-acquired and nasocomial UTI accounted for 63% and 37% of cases, respectively. The leading causative agents were Escherichia coli for community-acquired UTI and Klebsiella pneumoniae for nasocomial UTI. The urosepsis rate was 5%. Abnormal ultrasonography findings were present in 23% and vesicoureteral reflux was present in 15% of babies. A total of 23% of patients showed renal photopenic areas on dimercaptosuccinic acid scan. The recurrence rate was 28% occurring between 1.5 and 12 months, in particular in the first 6 months. Most of the recurrences developed in patients with no predisposing abnormalities. CONCLUSION: Pediatric nephrologic follow-up of babies experiencing UTI in the neonatal period is very important to identify the predisposing congenital abnormalities and scarred kidneys, to diagnose and to treat the recurrences earlier.     

新生儿泌尿系统感染41例临床分析

目的 探讨新生儿泌尿系感染的临床特点及其致病菌的分布和耐药情况，为临床诊断治疗提供依据。方法 对2002—2004年NICU收治的41例泌尿系感染新生儿的临床特点及其尿培养、药敏试验结果进行同顾性分析。结果 41例泌尿系感染新生儿中有泌尿道感染症状者4．9％（2例），黄疸60．1％（25例），发热53．7％（22例），腹泻26．8％（11例），体重不增9.8％（4例）。尿培养阳性73．2％（30例），其中大肠埃希菌14例，占46．7%；肺炎克雷伯菌7例，占23.3％；产气肠杆菌2例，占6．7％；阴沟杆菌1例，占3.3％；鹑鸡肠球菌2例，占6．7％；屎肠球菌1例，占3.3％；粪肠球菌1例，占3.3％；另有2例系大肠埃希菌分别并鹑鸡肠球菌和屎肠球菌混合感染。在全部16例大肠埃希菌中产超广谱13．内酰胺酶（ESBL）菌（＋）2例，占12．5％。药物敏感试验中，肠杆菌对美平、阿米卡星、环丙沙星、呋哺坦丁、头孢曲松、头孢噻肟钠敏感；肠球菌对万古霉素、利福平、环丙沙星、氯霉素、呋哺坦丁敏感；两者对氨苄青霉素均耐药。结论新生儿泌尿系感染临床表现不典型，多以全身症状为主，主要致病菌仍以大肠埃希菌为主，ESBL（＋）检出率有上升，主要致病菌对氨苄青霉素普遍耐药，经验用药不可取。     

机器人辅助腹腔镜行儿童上尿路手术的护理配合

目的总结机器人辅助腹腔镜行儿童上尿路手术的护理配合经验。方法回顾性分析2017年3月至2017年12月在解放军总医院第七医学中心,接受机器人辅助腹腔镜行上尿路手术140例患儿的临床资料,总结机器人辅助腔镜手术的术前准备、用物准备、手术布局和体位安置等护理配合注意事项。结果 140例患儿中男103例,女37例。平均体重为(18.1±15.0) kg,体重≥40 kg者39例,体重<40 kg者101例。手术的平均体位安置时间为(13.8±5.1)min。所有手术均顺利完成,无中转开放手术,未发生因手术布局及体位不当所导致的手术操作困难及术后相关并发症。结论良好的手术布局、体位安置是机器人辅助腹腔镜行儿童上尿路手术顺利开展与完成的重要前提。良好的手术布局有利于手术团队在手术中协作、交流与配合。良好的体位安置有利于发挥机器人手术优势、有助于主刀灵活操作及其与助手有效地配合,使手术更加安全、有效。     

Classification of pediatric urinary tract dilation: the new language

The multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system) was created to unify the language used to describe urinary tract dilation on antenatal and postnatal ultrasound examinations and thereby facilitate communication among providers and improve outcomes research. The background and new classification system are described in this review, with imaging examples.