Ultrasonography after the first febrile urinary tract infection in children

The importance of ultrasonography after the first febrile urinary tract infection has been recently challenged. The aim of this study was to evaluate the role of ultrasonography in detection of significant non-reflux abnormalities in the kidneys and the urinary tract, and to determine whether these findings influence treatment in these children. The clinical data and ultrasonography results of 155 children admitted to a university hospital with the first febrile urinary tract infection were analysed retrospectively. Renal ultrasonography was abnormal in 23 patients (14.8%). The major portion of these patients (81%) were younger than 2 years of age. Management of nine of these patients was changed based primarily on ultrasonography findings. Four of these patients were treated operatively. Conclusion: Our findings indicate that ultrasonography performed after the first urinary tract infection may offer clinically important information about non-reflux abnormalities in the kidneys and urinary tract that can affect the management of children with these complications.     

Antibiotic prophylaxis for children at risk of developing urinary tract infection: a systematic review

Background:  Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis.
Methods:  A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses.
Results:  A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69–1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75–1.78)].
Conclusion:  Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended.     

Imaging the urinary tract in children with urinary tract infection

Aim: To evaluate whether ultrasonography (US) alone is sufficient in imaging the urinary tract in 1185 children with urinary tract infection (UTI). Methods: The reports on US and voiding cystourethrography (VCUG) were reviewed. Results: Initial US was normal in 861/1185 patients (73%). VCUG revealed abnormal findings in 285/861 (33%), of which grade III–V vesicoureteral reflux (VUR) comprised 97 cases (11%). During follow‐up, VUR had resolved in 88/97 (91%) patients: in 50/57 (88%) patients without active treatment for VUR, in 27/29 (93%) with endoscopic and in 11/11 (100%) with open surgery for VUR. During follow‐up, 11/97 patients (11%) had developed new renal scarring detectable in US, but no renal impairment occurred. Except for VUR, VCUG showed nonobstructive urethral valves in two infant boys with normal initial US. Thus, in 861 children with normal initial US, 40 patients with grade III–V VUR and two patients with significant nonreflux pathology may have benefited from surgical treatment, giving the total number of possibly missed pathological finding in 42/861 (4.9%) cases if VCUG had not been performed. Conclusion: We suggest that children with UTI could be examined using US alone and to use VCUG only after additional indications.     

儿童泌尿系感染的诊治进展

泌尿系感染(urinary tract infection,UTI)是儿科常见的感染性疾病,早期识别和治疗可有效预防肾脏瘢痕形成,对肾脏远期预后具有重要意义.该文总结近年来儿童泌尿系感染相关文献,分别从临床表现、实验室检查、诊断标准和治疗等方面阐述国内外的研究现状,以期为儿童泌尿系感染的临床诊断和治疗提供参考.     

Radiological evaluation of the urinary tract in children with urinary infection

Objective: This article in to study the association of structural abnormalities of the urinary tract in children with urinary tract infection (UTI) using ultrasound examination.Methods : 262 children with culture proven urinary tract infection were studied. Antibiotics were given as per sensitivity pattern. All children had an ultrasound of the abdomen done within 3 weeks. A micturating cystourethrogram (MCU) was done in those with abnormalities of the lower urinary tract detected on ultrasound, as well as in those who had recurrence of infection, after a normal ultrasound. IVU and renal isotope scans were done in selected cases.Result : All children were followed up until one year after the study period. Fifty-four patients had an underlying urinary tract anomaly; 42 were picked up by ultrasound and 12 by MCU. 22.9% of males and 15.9% of females had anomaly of the urinary tract. Children less than 2 years had the highest incidence of anomalies.Conclusion : Pelviureteric junction obstruction with hydronephrosis, vesicoureteric reflux and non-refluxing megaureter are the major anomalies picked up. 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. An ultrasound abdomen is recommended in all children after the first UTI. In addition, an MCU is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done.     

儿童泌尿系统感染诊治进展

泌尿系统感染(UTI)是儿科最常见的细菌感染性疾病之一,约30%的婴幼儿在初次感染6~12个月反复发作。而在有泌尿系统发育畸形的儿童中,约30%的患儿以UTI为首发表现,故UTI可能是潜在肾脏结构异常的前哨事件。婴幼儿UTI常并膀胱输尿管反流等先天性尿路畸形,对于反复感染的高危患儿,易出现肾脏损害及肾瘢痕,进而导致终末期肾病。因此,早期识别、及时治疗和合理管理对改善预后十分重要。现总结近年来国内外相关文献,以期为儿童UTI的诊治提供临床参考。     

小儿泌尿系感染277例临床分析

目的探讨小儿泌尿系感染的临床特点及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1998—2006年首都医科研究所附属儿童医院肾脏病房收治的277例泌尿系感染患儿的临床特点、实验室检查、治疗及转归进行回顾性分析。结果145例尿培养前未应用过药物的患儿其尿培养阳性率为62.07%,132例培养前应用过药物的患儿其阳性率为20.45%,两者差异有统计学意义(P<0.05)。尿培养结果中大肠埃希菌有94例,对丁胺卡那霉素和头孢西丁的敏感率均在90%以上。结论抗生素的应用会大大降低尿培养的阳性率。大肠埃希菌为泌尿系感染的常见致病菌,头孢西丁可作为小儿泌尿系感染的首选用药。对首次发病的泌尿系感染患儿进行相应的影像学检查以排除一些潜在的病因是十分必要的。     

Risk factors for urinary tract infections in children aged 0–36 months presenting with fever without source and evaluated for risk of serious bacterial infections

BackgroundChildren younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm.MethodsWe designed a prospective cohort study. We included children aged 0–36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI.ResultsBetween October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1–1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3–24.3), fever for > 2 days (OR 29.1, 95% CI 3.5–243.5), and age < 9 months (OR: 45.3, 95% CI: 4.9–415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4–100%) and 21.4% (14.6–29.6%), respectively.ConclusionsIn the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.     

Low bacterial count urinary tract infections in infants and young children

The purpose of the study was to compare bacterial species, clinical, laboratory and imaging findings (^99m Tc-dimercaptosuccinic acid renal scan and voiding cystogram) in infants and children with high (10⁵ colony forming units (CFU)/ml, group A patients) and low (5×10⁴ CFU/ml, group C patients) bacterial count in urine cultures during first episode of urinary tract infection. Group B included patients with intermediate CFU/ml. Included were 419 symptomatic patients with: (a) no previous antibiotic treatment, (b) urine samples for quantitative cultures taken by bladder catheterisation or suprapubic bladder aspiration, (c) growth of only one microorganism, and (d) age 54 months (age of the oldest patient of group C). Out of 419 cultures, Escherichia coli grew in 315 (75.2%), gram-negative bacteria except E. coli in 91 (21.7%) and gram-positive in 13 (3.1%). Group C patients were significantly ( P <0.0001) more often affected with gram-negative pathogens except E. coli than group A patients (21/44 versus 67/360). Most of group C patients were younger than 24 months of age; none was older than 54 months. Comparison of the prevalence of clinical and laboratory (leucocyte count, CRP, ESR) findings between groups A and C showed no significant differences. There was no statistically significant difference in the prevalence of pyelonephritis, reflux and urological malformations (except reflux) between groups A and C. Conclusion: Low bacterial count urinary tract infections mainly affect infants and young children and are often due to gram-negative bacteria other than E. coli. Clinical and laboratory findings, prevalence of pyelonephritis, reflux and urological malformations are similar in high and low bacterial count urinary tract infections.     

儿童泌尿道感染诊治规范

泌尿道感染(UTI)是儿童最常见的感染性疾病之一。儿童UTI的临床症状可不典型,需结合尿沉渣分析与尿细菌学检查诊断,必要时需完善影像学评估有无泌尿系统发育畸形等。一旦诊断UTI需给予敏感抗菌药物治疗,抗菌药物选择应结合患儿一般情况、所在地区耐药发生率、既往用药史、尿细菌学药敏结果综合判断。此外,UTI并膀胱输尿管反流的...     

Staphylococcus saprophyticus urinary tract infections in children

Staphylococcus saprophyticus commonly causes urinary tract infection (UTI) in young women: in males it is found mainly in the elderly. In this studyS. saprophyticus UTI occurred in 59 children (45 girls and 14 boys) below 16 years of age, of whom 20 were less than 13 years of age. The common presentation was dysuria and flank or back pain whereas fever 38.5°C was rare. Radiological investigation performed in 63% of the children revealed no anomalies of importance. Children withS. saprophyticus UTI appear to constitute a group with a low frequency of urinary tract anomalies and with a low risk of UTI caused by other bacteria.     

Uncomplicated duplex kidney and DMSA scintigraphy in children with urinary tract infection

Background Renal duplication is the most common malformation of the urinary tract and is frequently seen among children with urinary tract infection (UTI). Objective To evaluate problems in the interpretation of dimercaptosuccinic acid (DMSA) scintigraphy and to establish the range of relative function in uncomplicated unilateral duplication. Materials and methods Retrospective analysis of 303 children less than 2 years of age with first time non-obstructive urinary tract infection investigated by both urography and DMSA scintigraphy. At DMSA scintigraphy, renal lesions and/or relative function below 45% was considered abnormal. Urography was used as reference for the diagnosis of duplication. Results Duplex kidneys were found in 22 of 303 patients (7%). Of the 16 children with unilateral duplication, 10 had bilaterally undamaged kidneys with a range of relative function varying between 51% and 57% in the duplex kidney. In two of the children with unilateral duplication the imaging results were discordant. Conclusion There was risk of underdiagnosis as well as overdiagnosis of renal damage at scintigraphy. Although it is important to be aware of this risk, the rate of misinterpretation was low. A range of 51% to 57% can be used as the limit for normality of the relative function of a unilateral duplex kidney.     

小儿尿路感染病原菌分布及耐药性分析

目的探讨小儿尿路感染的常见病原菌并分析其耐药情况。方法回顾性分析2018年1月至12月我院收治的108例尿培养阳性的尿路感染患儿的临床资料,分析其病原菌及抗菌药物耐药情况,并将患儿分为单纯尿路感染组(29例)和复杂尿路感染组(79例),对比两组革兰阴性菌耐药情况。结果共检出116株细菌,其中革兰阴性菌90株(77.59%),革兰阳性菌26株(22.41%)。其中大肠埃希菌、肺炎克雷伯菌、屎肠球菌为主要病原菌。革兰阴性菌对阿米卡星、亚胺培南、哌拉西林/他唑巴坦耐药率最低,在10%左右;对呋喃妥因、喹诺酮类药物耐药率在20%左右;对三、四代头孢菌素及其含酶抑制剂耐药率在30%~40%;未发现对万古霉素、利奈唑胺耐药的革兰阳性菌。革兰阳性菌对链霉素、呋喃妥因耐药率在0~20%。单纯尿路感染组与复杂尿路感染组中的革兰阴性菌对常见抗生素耐药率比较差异无统计学意义(P>0.05)。结论革兰阴性菌是尿路感染的主要病原菌,随着耐药情况的改变,可能需要改变经验性抗感染药物,呋喃妥因可以作为轻症患儿经验性应用的推荐,既往可能低估了单纯尿路感染病原耐药情况,需进一步研究。     

Risk factors for recurrent urinary tract infection in 4,332 Belgian schoolchildren aged between 10 and 14 years

To analyse the risk factors for recurrent urinary tract infection (UTI) and the possible influence of potty-training, a questionnaire with 41 questions was completed by 4,332 parents of children completing the last 2 years of normal primary school. Statistical analysis was done with the Chi-squared test and Yates correction. Three groups of children emerged: one without any history of UTI (n =3818), a group with one actual or former UTI (n =382) and a group with recurrent UTI (n =132). Mean age was 11.5±0.56 years. A strong correlation between daytime and/or night-time wetting, voiding frequency of more than 10 times a day and nocturia and recurrent UTI was found. No correlation between these factors and a single UTI could be demonstrated. In the 343 bed-wetting children, equal infections for boys and girls were found. Potty-training started significantly earlier in children without UTI. Parents of children with recurrent UTIs insisted more when the first attempt to void was unsuccessful: in the group without UTI, most parents just postponed and had the child try later again. In the group with recurrent UTI, more parents asked the child to strain, made special noises or turned on a tap. Conclusion:daytime with/without night-time wetting, more than 10 voidings a day and nocturia are indicators of recurrent urinary tract infections. If they are simultaneously present, the relative risk for recurrent urinary tract infections is 60%. Consequently, paediatricians should take urinary symptoms very seriously into account, and as incontinence is still a hidden condition, question the child on this topic.Abbreviations MNE monosymptomatic enuresis nocturna - UTI urinary tract infection - VUR vesicoureteral reflux     

Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age

A retrospective population-based study was performed to describe the incidence rate of first time symptomatic urinary tract infection in children under 6 y of age. A total number of 299 children was identified during the 20-month study period in a population of 20 000 girls and 21 000 boys. The cumulative incidence rate during the first 6y of life was 6.6% for girls and 1.8% for boys. The annual incidence rate in girls of urinary tract infection/1000 at risk was between 9 and 14 for each of the six 1-y age intervals. In girls, the proportion of febrile urinary tract infection was high during the infant year, while girls older than 2 y most often had non-febrile infection. For infant boys, the incidence rate and the proportion of febrile urinary tract infection were comparable to that of girls, while after the first year of life urinary infection of any kind was rare, with an incidence rate of 1–2/1000 at risk.