Protective effect of breastfeeding against urinary tract infection

Aim: To assess the possible protective effect of exclusive breastfeeding against first‐time febrile urinary tract infection (UTI) in children. Methods: Two children's hospitals and local child health centres in the Göteborg area, Sweden, participated in a prospective case‐control study. In total, 200 consecutive cases (89M, 11 1F), aged 0–6 y, presenting with first‐time febrile UTI were enrolled. The mean ± SD age was 0.98 ± 1.15y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure. Results: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long‐term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated. Conclusion: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.     

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...     

Diagnosing symptomatic urinary tract infections in infants by catheter urine culture

BACKGROUND: Diagnosing infantile urinary tract infection (UTI) is difficult due to contamination during urine collection. Catheterization is convenient but diagnostic criteria (colony-forming units per millilitre (CFU/mL)) is controversial, especially in uncircumcised males. OBJECTIVES: To study the value of catheter urine cultures in terms of likelihood ratios (LRs), sensitivity, specificity, positive and negative predictive values of different CFU/mL in uncircumcised boys and girls. METHODS: Infants aged 1-18 months who had catheter urine cultures from July 1999 to June 2002 were reviewed to decide if they had symptomatic UTI (group A) or not (group B). Urinary tract infection was confirmed if patients had a positive urine culture plus acute fever, pyuria, positive leucocyte esterase and nitrite tests and good response to antibiotics, with pyelonephritic evidence on early dimercaptosuccinic acid (DMSA) scans in doubtful cases. Group B included infants with negative urine culture results, and those with positive results but were asymptomatic and admitted for micturating cystourethrogram. RESULTS: Nine hundred and fifty-two patients were studied (492 boys, 460 girls; 212 in group A, 740 in group B). No single cut-off CFU/mL has high sensitivity and specificity to simultaneously diagnose and exclude UTI. The CFU counts of 100-10(3), 10(3)-10(4), 10(4)-10(5) and >10(5) were associated with LRs of 0.11, 0.45, 1.52 and 20.5, respectively in uncircumcised boys, and with LRs of 1.39, 2.49, 8.95 and 18.8, respectively in girls. The LR for mixed growths was 0.21. CONCLUSION: Unlike suprapubic tap urine, catheter urine culture has to be interpreted against the clinical context or pretest probability and in terms of probability. In the scenario of a febrile infant where the pretest probability of UTI was about 5%, UTI was highly likely if counts exceeded 10(5)/mL, and unlikely if counts were below 10(4)/mL in uncircumcised boys. In female infants, UTI was highly likely if counts were >10(4) CFU/mL, but lower counts could not exclude UTI.     

儿童泌尿系感染的流行病学与诊治

泌尿系感染是儿科常见的感染性疾病,严重者可引发菌血症而危及生命;肾盂肾炎可导致慢性肾功能不全.由于儿童泌尿系感染的发病率有其独特的特点,临床上又缺乏典型的症状,以至有关儿童泌尿系感染患病率的研究较多,但结果各有差异.文章结合近年来儿童泌尿系感染的研究进展,讨论该病的流行病学、诊断和治疗等相关问题.     

Suprapubic voiding cystourethrography in the evaluation of lower urinary tract

Suprapubic micturating cystourethrography is a technique of great value in evaluating lower urinary tract in infants and children. It has been employed in 28 patients of age group ranging from newborn to 12 years, without any serious complication. The minor complication of extravasation of contrast media into the perivesical and peritoneum was observed in three patients. The method is easy, safe, reliable and time saving.     

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。     

Asymptomatic urinary tract infection in childhood

In this study 2591 apparently healthy children aged 1 day–16 years were examined to determine the existence of asymptomatic urinary tract infection. A prevalence of 4% in newborns, 5.2% in infants, 5.8% in preschool children, 4.5% in elementary school children, and of 4.8% in high-school children was found.     

尿路感染合并无菌性脑膜炎1例报告及文献复习

目的探讨尿路感染合并无菌性脑膜炎的临床特点、发病机制及诊治,以提高对此疾病的认识。方法分析1例尿路感染合并无菌性脑膜炎患儿的临床特点和实验室检查结果,并复习相关文献。结果患儿2月龄,临床表现为发热、颈抵抗及前囟隆起,伴有尿道口充血及异常分泌物。脑脊液白细胞计数30×106/L。患儿血培养、脑脊液培养均阴性。尿培养为屎肠球菌生长。经静脉抗感染治疗10 d,病情好转,随访病情无复发。结论尿路感染患儿可合并无菌性脑膜炎,其机制可能与细菌感染引起脑膜炎症反应有关,临床上需与细菌性脑膜炎进行鉴别,如明确为前者可适当缩短抗感染疗程。     

Antibacterial prophylaxis in children with urinary tract infection

The aim, in conservative management of vesico-ureteric reflux by antimicrobial prophylaxis, is to prevent recurrent febrile urinary tract infections and consequent renal scarring. However, the effects of this prophylactic strategy are difficult to evaluate, since the required studies comparing children on prophylaxis with controls (without prophylaxis but under careful supervision) are lacking. Furthermore, the optimal length of prophylaxis needs to be defined. Since risk of renal scarring is believed to occur more frequently in young people, and since recurrent urinary infections mainly affect girls, the age and sex of subjects are important in the design of a prophylactic regimen. Nitrofurantoin and trimethoprim are the most common agents used for long-term, low-dose antibacterial prophylaxis. Break-through infections still result from non-compliance and from development of bacterial resistance, the latter mainly arising with trimethoprim. Few studies of prophylactic drugs are available that adequately define patient materials and include a random allocation to the different agents. Further studies of the effects of alternative prophylactic agents are called for, preferably combined with fresh insight into the ecological impact on the bowel and periurethral floras.     

Melamine-contaminated milk products induced urinary tract calculi in children

Background  Melamine is an industrial chemical used primarily as plastics stabilizer and fire retardant. On September 11, 2008, melamine-contaminated milk products were reported to be responsible for urinary tract calculi in infants and children in China. This study aimed to investigate the prevalence, lesions, risk factors, clinical features, and management of children fed with the melamine-contaminated milk products. Methods  A total of 15 577 infants and children fed with the milk products were screened at our hospital. Ultrasonography was performed in all the infants and children. For those found with urinary tract calculion ultrasonography, urnalysis was done. Among them, 846 with detailed data screened from September 17 to 25 were enrolled for further analysis in this study. They were divided into calculus group (326 children) and non-calculus group (520 children) according to the results of ultrasonography. They included 429 boys and 417 girls, aged from 1 month to 5 years (median, 18 months). Their clinical and laboratory data, ultrasonograms, and treatment results were analyzed. Results  Of the 15 577 children screened, 562 (3.61%) had urinary tract calculi. The rate was closely related to the melamine concentration in patients fed with formula. In 846 children with detailed data enrolled in this analysis, weight and head circumference Z scores in the calculus group were lower than those in the non-calculus group (P=0.048, P=0.046). Long duration of formula feeding, high melamine contained formula, and minimal water intake were the risk factors for calculi (P<0.05, respectively). Of 326 children with calculi, 281 had small calculiless than 0.5 cm in diameter, 227 had multiple calculi, and 34 had urinary tract distention. Moreover, diffuse renal lesions, renal failure and ascites were noted in 4, 3 and 2 patients, respectively. After 1-month treatment with sodium bicarbonate and Chinese traditional medicine, calculi disappeared in 49 of 54 outpatients. In 41 inpatients, 5 had calculi removed operatively and 36 had calculi minimized. Conclusions  Melamine-contaminated milk products induced urinary tract calculi, which have a good response to conservative therapy. Long-term follow-up of infants and children fed with melamine-contaminated milk products is required, and food safety should be supervised increasingly for the health of children.     

Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection

Background  This study was undertaken to determine the incidence of urinary tract infection (UTI) and the frequency of anatomical abnormalities in newborns with unexplained jaundice and to find out if there is any correlation between bilirubin level and renal damage. Methods  We studied 462 full-term neonates for UTI. They were aged 3–25 days, with either high (>10 mg/dL) or prolonged (>10 days) hyperbilirubinemia, with or without manifestations such as fever, vomiting, diarrhea, poor feeding, lethargy, and irritability. Neonates positive for UTI were further investigated with ultrasound, cystourethrography, and acute phase renal scintigraphy with technetium-99m dimercaptosuccinate acid (DMSA). Results  Thirty neonates (6.5%) were found to have UTI. Twenty-eight of them had indirect hyperbilirubinemia and two had direct hyperbilirubinemia, with total bilirubin levels of 11.8–20.1 mg/dL. None of the neonates was found to have jaundice because of other reasons such as infection. Vesicoureteral reflux was found in 5 neonates and one of them was combined with hydronephrosis. Renal scintigraphy with technetium-99m DMSA showed renal cortex changes in 14 (46.7%) of the 30 neonates with UTI. These 14 neonates also had increased levels of bilirubin in comparison to those with normal findings of DMSA. Conclusions  The incidence of UTI in uncomplicated neonatal jaundice is relatively high. Anatomical abnormalities of the urinary tract are not rare in infected children. Increased bilirubin levels are related to pathological findings in renal scintigraphy.     

Neonatal Staphylococcus lugdunensis urinary tract infection

Staphylococcus lugdunensis is a known pathogen of infective endocarditis, but not of urinary tract infection. We report a previously healthy neonate without congenital anomalies of the kidney and urinary tract who developed urinary tract infection due to Staphylococcus lugdunensis, illustrating that Staphylococcus lugdunensis can cause urinary tract infection even in those with no urinary tract complications.     

儿童泌尿系感染临床管理现状分析

目的初步了解儿童泌尿系感染临床管理现状,为今后制订适于我国实际的临床指南提供参考。方法对自1994年至2003年间入院诊断泌尿系感染(泌感)的患儿病史进行回顾性分析,通过电话回访了解出院后的随诊情况。结果74例入院诊断泌感的患儿,最终仅有20例(27.0%)符合严格的泌尿系感染诊断标准。仅有11例(14.9%)完成多项影像学检查(包括B超及膀胱输尿管反流筛查),膀胱输尿管反流阳性2例。回访成功41例,其中仅13例(31.7%)出院后在门诊定期随诊,8/13例仍有反复泌尿系感染。结论①按照严格的泌尿系感染诊断标准,许多入院时的泌感诊断不能成立,将被纠正;②寻找泌感潜在病因时影像学检查不够充分,这可能是膀胱输尿管反流诊断率相对低(2/20例,10.0%)的原因之一;③泌感患儿随诊率极低,有碍于控制泌感复发。今后确应重视小儿泌尿系感染的严格诊断程序、影像学检查及随诊管理。     

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.     

儿童泌尿道感染中膀胱输尿管反流发生率的临床研究

目的回顾性分析儿童泌尿道感染中膀胱输尿管反流(VUR)的发生情况,以加强对VUR的认识,提高检出率。方法选择2000年1月到2006年11月因泌尿道感染收治入院的患儿106例,根据年龄分为≤2岁组、～5岁组、>5岁组三组,通过排泄性膀胱尿道造影(VCUG)和直接放射性核素造影诊断VUR;通过肾皮质静态显像(DMSA)检查,了解肾疤痕的形成情况。分析不同年龄组的VUR发病情况、不同等级VUR的程度和肾疤痕的形成分布情况。结果106例中VUR共40例,不同年龄组VUR的所占比例分别是77.78%、46.67%、27.90%(χ2=12.994,P=0.002),差异具有统计学意义。106例中有40例作了DMSA检查,14例形成肾疤痕,三组间肾疤痕的分布情况依次是66.7%、30.77%、28.57%,≤2岁组肾疤痕发生率高。另外,从VUR的等级分布和单、双侧VUR发生的情况来看,≤2岁组中VUR患儿主要是Ⅲ、Ⅳ、Ⅴ级,而～5岁组和>5岁组则随着年龄的逐渐增加Ⅰ、Ⅱ级的例数增加,Ⅲ、Ⅳ、Ⅴ级的例数减少;而且≤2岁组的VUR患儿双侧VUR的例数也较后两组多。结论≤2岁的泌尿道感染患儿最易形成肾疤痕,VUR的发病率高,且高级别、双侧VUR的发生率高,应及时行VCUG和DMSA,及早发现VUR和肾疤痕。