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Cajigas-Loyola SC, Chow JS, Hayatghaibi S, Iyer RS, Kwon J, Rubesova E, Sánchez-Jacob R, Wyers M, Otero HJ. Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329741. [PMID: 37672329 DOI: 10.2214/ajr.23.29741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequelae requiring surgery but can also spontaneously resolve without complication. Therefore, recognizing patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR is important, as is avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrography, radionucleotide cystography, and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.
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Affiliation(s)
- Stephanie C Cajigas-Loyola
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, Seattle, WA
| | - Jeannie Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Erika Rubesova
- Department of Radiology, Stanford Medicine Children's Health, Palo Alto, CA
| | | | - Mary Wyers
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
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Damasio MB, Donati F, Bruno C, Darge K, Mentzel HJ, Ključevšek D, Napolitano M, Ozcan HN, Riccabona M, Smets AM, Sofia C, Stafrace S, Petit P, Ording Müller LS. Update on imaging recommendations in paediatric uroradiology: the European Society of Paediatric Radiology workgroup session on voiding cystourethrography. Pediatr Radiol 2024; 54:606-619. [PMID: 38467874 DOI: 10.1007/s00247-024-05883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Voiding cystourethrography (VCUG) is a fluoroscopic technique that allows the assessment of the urinary tract, including the urethra, bladder, and-if vesicoureteral reflux (VUR) is present-the ureters and the pelvicalyceal systems. The technique also allows for the assessment of bladder filling and emptying, providing information on anatomical and functional aspects. VCUG is, together with contrast-enhanced voiding urosonography (VUS), still the gold standard test to diagnose VUR and it is one of the most performed fluoroscopic examinations in pediatric radiology departments. VCUG is also considered a follow-up examination after urinary tract surgery, and one of the most sensitive techniques for studying anatomy of the lower genitourinary tract in suspected anatomical malformations. The international reflux study in 1985 published the first reflux-protocol and graded VUR into five classes; over the following years, other papers have been published on this topic. In 2008, the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force published the first proposed VCUG Guidelines with internal scientific society agreement. The purpose of our work is to create a detailed overview of VCUG indications, procedural recommendations, and to provide a structured final report, with the aim of updating the 2008 VCUG paper proposed by the European Society of Paediatric Radiology (ESPR). We have also compared VCUG with contrast-enhanced VUS as an emergent alternative. As a result of this work, the ESPR Urogenital Task Force strongly recommends the use of contrast-enhanced VUS as a non-radiating imaging technique whenever indicated and possible.
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Affiliation(s)
- Maria Beatrice Damasio
- Pediatric Radiology Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Francesco Donati
- Pediatric Surgery Department, University of Genova, Genoa, Italy
| | - Costanza Bruno
- Radiology Department, AOUI Verona (Azienda Ospedaliera Universitaria Integrata), Verona, Italy
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Universitätsklinikum Jena, Jena, Germany
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - H Nursun Ozcan
- Department of Radiology/Division of Pediatric Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Anne M Smets
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Samuel Stafrace
- McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Philippe Petit
- Department of Pediatric Radiology, Hopital Timone Enfants, Aix Marseille-Université, Marseille, France
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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3
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Hewitt IK, Roebuck DJ, Montini G. Reply to De Palma D. Pediatr Radiol 2024; 54:657-658. [PMID: 38488926 DOI: 10.1007/s00247-024-05906-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Ian K Hewitt
- Department of Pediatric Nephrology, Perth Children's Hospital, Nedlands, 6009, Australia
| | - Derek J Roebuck
- Division of Pediatrics, Medical School, University of Western Australia, Crawley, 6009, Australia.
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, 6009, Australia.
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda IRCCS, Policlinico di Milano, Milan, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
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Cetin N, Kocaturk E, Tufan AK, Kiraz ZK, Alatas O. Diagnostic Values of Immature Granulocytes Detected by the Sysmex XN 9000 Hematology Analyzer in Children with Urinary Tract Infections. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:S133-S141. [PMID: 38995281 DOI: 10.4103/sjkdt.sjkdt_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Immature granulocytes (IGs) are used as markers of infection and systemic inflammation. We aimed to investigate the diagnostic value of IGs in children with urinary tract infections (UTIs). Children with their first UTIs were included in this observational study. Blood samples were obtained before antibiotic therapy. The blood analysis was repeated 2 weeks after the treatment ended. In total, 194 children (95 with febrile UTI, 58 with cystitis, and 41 controls) were included. The percentage of IGs (IG%) and IG count (IGC) measured at the time of admission were higher in the patients with febrile UTI than in the patients with cystitis and the controls (P = 0.000). The IGC and IG% after treatment were higher in patients with renal scarring than in those without scarring (P = 0.012 and P = 0.021, respectively). Cox's regression analysis showed the significant associations of renal scarring with both IGC and IG% (hazard ratio: 8.181, P = 0.002; hazard ratio: 5.106, P = 0.033, respectively). Both IGC and IG% were positively associated with severe vesicoureteral reflux (VUR) [odds ratio (OR): 22.235, P = 0.025; OR: 15.597, P = 0.038, respectively]. In conclusion, the IG% and IGC, which can be easily measured in a routine complete blood count without the need for additional effort, could be used as biomarkers for predicting febrile UTI, renal scarring, and severe VUR in children.
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Affiliation(s)
- Nuran Cetin
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Evin Kocaturk
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Asli Kavaz Tufan
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Zeynep Kusku Kiraz
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozkan Alatas
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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5
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Elgormus Y, Okuyan O, Dumur S, Sayili U, Uzun H. Evaluation of new generation systemic immune-inflammation markers to predict urine culture growth in urinary tract infection in children. Front Pediatr 2023; 11:1201368. [PMID: 37920790 PMCID: PMC10618680 DOI: 10.3389/fped.2023.1201368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
Objective Systemic inflammation has been implicated in the development and progression of urinary tract infection (UTI). Accordingly, the aim of this study is to determine whether the white blood cell (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are useful markers to predict of urine culture growth in children with UTI. The second aim of this study is to evaluate the prevalence of UTI pathogens, antibiotic resistance patterns, and empirical treatment options in children diagnosed with UTI based on laboratory and clinical findings. Method The study population comprised 413 cases (positive urine culture) and 318 cases (negative urine culture) of pediatric patients with UTI. Results There was no statistically significant difference observed in the median levels of hemoglobin, hematocrit, and platelet between the negative and positive culture groups. The median levels of monocytes, WBC, NLR, SII, and CRP of the patients with a positive urine culture were shown to be statistically significantly higher than the patients with a negative urine culture. The AUC value was 0.747 (0.710-0.784) for CRP with a cutoff value of 3.2, the sensitivity value was 56.4%, and the specificity value was 98.4% in terms of UTI. The AUC value was 0.733 (0.697-0.769) for SII with a cutoff value of 600, the sensitivity value was 58.4%, and the specificity value was 83.0%. The AUC value was 0.732 (0.697-0.769) for NLR with a cutoff value of 2, the sensitivity value was 57.4%, and the specificity value was 81.1%. Conclusion WBC, CRP, NLR, PLR, and SII could potentially serve as useful independent diagnostic or complementary markers for disease in children diagnosed with UTI who exhibit a positive urine culture. Escherichia coli was found to be the most common causative agent, and the commonly prescribed antibiotic was cephalosporin. However, it was observed that all identified agents of pediatric UTIs in our center exhibited high resistance to cefuroxime, trimethoprim-sulfamethoxazole, cefixime, ampicillin, and ceftriaxone.
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Affiliation(s)
- Yusuf Elgormus
- Clinic of Pediatrics, Medicine Hospital, İstanbul, Türkiye
| | - Omer Okuyan
- Department of Pediatrics, Medicine Hospital, Istanbul Atlas University, Istanbul, Türkiye
| | - Seyma Dumur
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Türkiye
| | - Ugurcan Sayili
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Türkiye
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Goodarzi R, Yousefimashouf R, Sedighi I, Moradi A, Taheri M. Effect of thymol on antimicrobial susceptibility, and adhesion genes expression of uropathogenic Escherichia coli isolated from pediatric urinary tract infection. J Pediatr Urol 2023; 19:654.e1-654.e7. [PMID: 37481428 DOI: 10.1016/j.jpurol.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) is a common cause of urinary tract infections (UTI) in children and currently is one of the leading medical problems. Due to the increase in antibiotic resistance rate, herbal medicines with lower side effects were considered. OBJECTIVE This study aimed to identify the afa, fimH, and sfa genes of UPEC bacteria isolated from pediatric UTI to investigate the effect of the thyme on the expression of fimH gene. STUDY DESIGN In this cross-sectional study, 160 UPEC were isolated from pediatric UTIs. An antibiotic susceptibility test was performed on six families of antibiotics, including beta-lactams, quinolones, aminoglycosides, carbapenems, sulfonamides, and nitrofurantoin. The micro-broth dilution method was used to determine MIC of thymol. The biofilm production ability of isolated strains was quantified by the microtiter plate method. The PCR technique was used to detectfimH, afa, and sfa adhesion genes, and real-time PCR was used to measure the fimHgene expression. RESULTS The results of the antibiogram showed that the lowest and highest resistance related to meropenem and imipenem (zero), and 72.5% for cephalothin. MIC showed 80.7% of the isolates were sensitive to thymol. The biofilm production results showed that 3.12%, 53.75%, and 43.12% of the isolates were strong, weak, and no-biofilm (Zero) producers, respectively. After thymol treatment, 26.25% and 73.75% of isolates were weak and no-producer (Zero) biofilms, respectively and there was a significant correlation (P-value = 0.042) compared to the control group. The frequency of fimH, sfa, and afa genes was 53.1%, 49.4%, and 29.4%, respectively. The expression of fimHgene after 48 h thymol treatment decreased significantly (P-value< 0.05). CONCLUSION Due to the significant effects of thymol in preventing the expression of the adhesion gene (fimH) of UPEC bacteria, our study is a proof-of-concept study evaluating bacterial sensitivity to Thymol and its effect on biofilm production in vitro. Given the demonstrated promising results of Thymol's effectiveness and the increase in bacterial antibiotic resistance, further studies should be undertaken to determine the safety and effectiveness of Thymol use in the clinical treatment of urinary tract infection. We believe that Thymol may prove to be an effective adjunct to the treatment of bacterial urinary tract infections.
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Affiliation(s)
- Rezvan Goodarzi
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasoul Yousefimashouf
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Sedighi
- Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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Chieng CCY, Kong Q, Liou NSY, Khasriya R, Horsley H. The clinical implications of bacterial pathogenesis and mucosal immunity in chronic urinary tract infection. Mucosal Immunol 2023; 16:61-71. [PMID: 36642381 DOI: 10.1016/j.mucimm.2022.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023]
Abstract
Urinary tract infections (UTIs) exert a significant health and economic cost globally. Approximately one in four people with a previous history of UTI continue to develop recurrent or chronic infections. Research on UTI has primarily concentrated on pathogen behavior, with the focus gradually shifting to encompass the host immune response. However, these are centered on mouse models of Escherichia coli infection, which may not fully recapitulate the infective etiology and immune responses seen in humans. The emerging field of the urobiome also inadvertently confounds the discrimination of true UTI-causing pathogens from commensals. This review aims to present a novel perspective on chronic UTI by linking microbiology with immunology, which is commonly divergent in this field of research. It also describes the challenges in understanding chronic UTI pathogenesis and the human bladder immune response, largely conjectured from murine studies. Lastly, it outlines the shortcomings of current diagnostic methods in identifying individuals with chronic UTI and consequently treating them, potentially aggravating their disease due to mismanagement of prior episodes. This discourse highlights the need to consider these knowledge gaps and encourages more relevant studies of UTIs in humans.
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Affiliation(s)
| | - Qingyang Kong
- Department of Microbial Diseases, Eastman Dental Institute, University College London, London, United Kingdom
| | - Natasha S Y Liou
- Department of Renal Medicine, University College London, London, United Kingdom; EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Rajvinder Khasriya
- Department of Microbial Diseases, Eastman Dental Institute, University College London, London, United Kingdom
| | - Harry Horsley
- Department of Renal Medicine, University College London, London, United Kingdom.
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Daniel M, Szymanik-Grzelak H, Sierdziński J, Podsiadły E, Kowalewska-Młot M, Pańczyk-Tomaszewska M. Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. J Pers Med 2023; 13:jpm13010138. [PMID: 36675799 PMCID: PMC9865477 DOI: 10.3390/jpm13010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The study aimed to determine the clinical symptoms, laboratory tests, risk factors, and etiology of different UTIs in children admitted to pediatric hospitals for three years. Methods: Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. Results: We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5−48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in children with APN than with CYS. The risk factors of UTIs were presented in 46.6% of patients, of which 35.6% were children with APN and 61.7% with CYS. The main risk factor was CAKUT, more frequently diagnosed in children with CYS than APN, mainly in children <2 years. The most commonly isolated bacteria were Escherichia coli (74%). There was a higher percentage of urine samples with E. coli in girls than in boys. Other bacteria found were Klebsiella species, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus species. Conclusions: Patients with APN were younger and had higher inflammatory markers. Often, fever is the only symptom of UTI in children, and other clinical signs are usually non-specific. The most common UTI etiology is E. coli, regardless of the clinical presentation and risk factors.
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Affiliation(s)
- Maria Daniel
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence: ; Tel.: +48-317-97-35
| | - Hanna Szymanik-Grzelak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Edyta Podsiadły
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research, Faculty of Pharmacy, Medical University of Warsaw, 02-091 Warsaw, Poland
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Muacevic A, Adler JR, Verma PK, Bhat NK, Shrivastava Y, Yhoshu E, Bhatia M, Chacham S. Clinico-Microbiological Profile and Clinical Predictor of Urinary Tract Infection in Children: A Single-Center Study From Himalayan Foothills. Cureus 2023; 15:e33289. [PMID: 36741629 PMCID: PMC9892952 DOI: 10.7759/cureus.33289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) in children is one of the commonest bacterial infections seen in the pediatric population. Clinical presentation ranges from fever with or without focus and isolation of microbiological agents streamline the treatment. Moreover, local/regional microbial profiles are helpful in antibiotic selection, we conducted a study to assess the prevalence of urine culture positivity in a suspected case of UTI. In addition, antibiotic susceptibility patterns and ultrasonography (USG) finding in culture-positive patients were also studied. METHODS AND MATERIALS It is a prospective observational study comprising symptomatic children aged one month to 18 years presenting to the outpatient department (OPD), inpatient department (IPD), and the emergency department of Pediatrics with UTI during the period of September 2019 to September 2020. The recorded variables were demographic, clinical presentation, anthropometry, physical examination, blood biochemistry, and outcome. Urine samples were collected and processed as per standard protocols. USG was done for all culture-positive children. Data were presented as frequency, mean (SD) and parametric and non-parametric data were analyzed by Wilcoxon-Mann-Whitney U Test, Chi-Squared Test, or Fisher's Exact Test. Results: Of the total 354 children, 202 (57.1%) were male and the prevalence of UTI was 64 (18.1%). E. coli (70.3%) was the commonest isolated organism followed by Klebsiella spp (15.6%) and Pseudomonas spp (7%) respectively. The mean (SD) age (months) of presentation of symptoms was significantly lower in culture-positive children as compared to [ 83.49 (58.96) vs 110.10 (58.60); p=0.001] culture-negative children. Fever (96.6%) followed by dysuria (20.1%) were the most common symptoms presented for UTI however dysuria (p=0.003), pus cells (p<0.0001), and RBCs (p=0.002) were significantly present in culture positive children. This study shows increased resistance to third generation of cephalosporins. This study revealed significant differences among various groups (organism growth in positive culture) and the Antibiotic susceptibility test (AST) with a p-value of <0.001. Conclusion: The prevalence of culture-positive UTI was similar to the reported literature and the presence of fever, dysuria, pus cells, and RBC in urine were commonly observed in the lower age group. Amikacin can be used in suspected UTIs with cephalosporin as empirical antibiotics in the Himalayan Foothills region.
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Tendencias en la hospitalización por infección del tracto urinario en la población pediátrica de España en el período 2000-2015. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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11
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Bezruk VV, Shkrobanets ID, Godovanets OS, Buriak OH, Pervozvanska OI, Honcharuk LM, Voytkevich NI, Makarova OV, Yurkiv OI, Sheremet MI, Hresko MM, Velia MI, Yurniuk SV, Hresko MD, Bulyk TS, Rynzhuk LV. Management of antibacterial therapy of infectious and inflammatory diseases of the urinary tract in children and regional peculiarities during the COVID-19 pandemic. J Med Life 2022; 15:617-619. [PMID: 35815078 PMCID: PMC9262259 DOI: 10.25122/jml-2021-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
Urinary tract infections (UTIs) remain an urgent issue in clinical pediatrics. Empirical selection of antibacterial therapy becomes more complicated, and antibacterial drug indication is not always clinically substantiated. This study aimed to compare the antibacterial susceptibility pattern of the main group of urinary tract infectious agents from 2009–2016 with intermediate results from 2020–2021, during the COVID-19 pandemic, among children in the Chernivtsi region. Urine samples were collected from 3089 children (0–17 years old) treated at the health care institutions in the Chernivtsi region (2009–2016). The clinical-laboratory examination of 177 children (0–17 years old) was carried out from 2020 to 2021. The children received specialized medical care at the Department of Nephrology. Preliminary data of regional monitoring (2020–2021) are not considerably different from the previous regional susceptibility of antibiotics: to penicillin (p<0.01), ІІ-ІІІ generation cephalosporin (p<0.01); an increased resistance to levofloxacin (χ2=4,338; p<0.01), tetracycline – χ2=7,277; p<0.01; doxycycline – χ2=5,309; p<0.01) and imipenem – χ2=5,594; p<0.01). The data obtained did not explain an increased resistance to fluoroquinolones completely (ofloxacin, pefloxacin, ciprofloxacin), except for levofloxacin (χ2=4,338; p<0.01). A reliable difference of susceptibility of tetracycline group was registered (tetracycline – χ2=7,277; p<0.01; doxycycline – χ2=5,309; p<0.01). Furthermore, there was a regional increase in some UTI-pathogen strains resistant to carbapenems (imipenem – χ2=5,594; p<0.01). The use of antibiotics from the group of penicillins and II-III generation cephalosporins as the starting antibacterial therapy for STIs during the COVID-19 pandemic should be justified. A regional increase (2020–2021) of some uropathogenic strains resistant to carbapenems administered to treat severe bacterial infections requires their exclusively designated purpose in everyday pediatric practical work.
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Affiliation(s)
- Volodymyr Volodymyrovych Bezruk
- Department of Pediatrics, Neonatology and Perinatology Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine,Corresponding Author: Volodymyr Volodymyrovych Bezruk, Department of Pediatrics, Neonatology and Perinatology Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine. E-mail:
| | - Igor Dmytrovych Shkrobanets
- Department of Medical and Organizational Management, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Oleksii Serhiiovych Godovanets
- Department of Pediatrics, Neonatology and Perinatology Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Oleksandr Hryhorovych Buriak
- Department of Pediatrics, Neonatology and Perinatology Medicine, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | | | | | - Olena Victorivna Makarova
- Department of Care for Patients and Higher Nursing Education, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Oksana Ivanivna Yurkiv
- Department of Care for Patients and Higher Nursing Education, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | | | | | | | - Maryna Dmytrivna Hresko
- Department of Obstetrics and Gynecology, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Tetiana Sergiivna Bulyk
- Department of Obstetrics and Gynecology, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Larysa Vasylyvna Rynzhuk
- Department of Obstetrics and Gynecology, Bukovinian State Medical University, Chernivtsi, Ukraine
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Zhu B, Liu Y, Wang H, Duan F, Mi L, Liang Y. Clinical guidelines of UTIs in children: quality appraisal with AGREE II and recommendations analysis. BMJ Open 2022; 12:e057736. [PMID: 35477875 PMCID: PMC9047976 DOI: 10.1136/bmjopen-2021-057736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To explore the current Chinese and English guidelines of urinary tract infection (UTI) in children and provide a summary of the recommendations of the guidelines. METHODS An electronic search was conducted on databases, including Pubmed, SinoMed, Wangfang Data, CHKD,VIP, NICE, WHO, GIN and Medliveto retrieve data of the clinical practice guidelines on UTI from the establishment of the database to June 2020. Four assessors assessed the quality of guidelines using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and evaluated the specific recommendations in guidelines. RESULTS (1) Nine guidelines including two from the USA (AAP and A guideline for the inpatient care of children with pyelonephritis) and the remaining from EAU/ESPU, SINEPE, KHA-CARI, CPS, ISPN, NICE and CMA-CSP were explored. (2) The AGREE II evaluation demonstrated higher scores of UTI guidelines in terms of 'scope and purpose' (72.99%±11.19%) and 'clarity of presentation' (75.62%±7.75%), whereas the average scores were lower in the aspect of 'stakeholder involvement' (35.49%±14.41%), 'rigour of development' (37.05%±10.05%), 'applicability' (37.75%±11.98%) and 'editorial independence' (43.06%±48.14%). The average scores of the guidelines were as follows: SINePe (72.57%), CMA-CSP (62.96%), EAU/ESPU (59.61%), AAP (56.86%), NICE (47.54%), CPS (40.93%), KHA-CARI (38.86%), ISPN (38.63%) and A guideline for the inpatient care of children with pyelonephritis (34.72%). (3) All the selected guidelines basically reached a consensus on urine sample retention methods in older children, the antibiotic treatment course and renal and bladder ultrasonography application but lacked a conclusion on the determination of urine culture results, the choice of voiding cystourethrography and Tc-99mdimercaptosuccinicacid, and antibiotic prophylaxis. CONCLUSION There remains a need to improve the quality of guidelinesfor UTI in clinical practice. Existing controversies on the current guidelines of UTI in some recommendations warrant further exploration to provide more evidence on formulating more unified and practical guidelines in the future. ETHICS AND DISSEMINATION No ethical approval is required for this research, as it did not include patients or patient data.
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Affiliation(s)
- Binhui Zhu
- Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- School of Pediatrics, Capital Medical University, Beijing, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hui Wang
- Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Chronic Renal Diseases and Blood Purification, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fan Duan
- Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- School of Pediatrics, Capital Medical University, Beijing, China
| | - Lan Mi
- Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- School of Pediatrics, Capital Medical University, Beijing, China
| | - Ying Liang
- Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Chronic Renal Diseases and Blood Purification, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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13
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Bitew A, Zena N, Abdeta A. Bacterial and Fungal Profile, Antibiotic Susceptibility Patterns of Bacterial Pathogens and Associated Risk Factors of Urinary Tract Infection Among Symptomatic Pediatrics Patients Attending St. Paul’s Hospital Millennium Medical College: A Cross-Sectional Study. Infect Drug Resist 2022; 15:1613-1624. [PMID: 35418760 PMCID: PMC8995149 DOI: 10.2147/idr.s358153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Urinary tract infection is a common infection in pediatrics. Understanding the common etiology of urinary tract infections, their antimicrobial susceptibility pattern, and associated risk factors in a particular setting can provide evidence for the appropriate treatment of the cases. Purpose The current study is aimed to determine the common etiology and prevalence of uropathogens associated with urinary tract infection, as well as the antibiotic susceptibility profile of bacterial isolates, and to identify risk factors associated with urinary tract infection among pediatric patients. Materials and Methods The study was conducted at St. Paul Hospital Millennium Medical College between October 2019 and July 2020. Urine was collected aseptically from patients, inoculated onto culture media, and incubated at 37 °C for 18–48 hours. Bacteria and yeast were identified following standard procedures. Antibiotic susceptibility testing of bacterial pathogens was carried out by the Kirby Bauer disc diffusion method. Descriptive statistics and logistical regressions were used to estimate the crude ratio with a 95% confidence interval. P-value < 0.05 was considered significant. Results Significant bacterial/fungal growth was observed in 65 samples giving a prevalence of 28.6% of which 75.4% (49/65) and 24.6% (16/65) were bacterial and fungal pathogens, respectively. About 79.6% of bacterial etiology were Escherichia coli and Klebsiella pneumoniae. The highest resistance was observed against ampicillin (100%), cefazolin (92.1%), and trimethoprim-sulfamethoxazole (84.1%), both of which are commonly used for empirical treatment in Ethiopia. Length of hospital stay (P=0.01) and catheterization (P=0.04) were statistically associated with urinary tract infection. Conclusion The high prevalence of urinary tract infection was observed in our study. Enterobacteriaceae were the major cause of urinary tract infection. Length of hospital stay and catheterization were significantly associated with urinary tract infection. Both Gram-negative and Gram-positive bacteria were extremely resistant to ampicillin and trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nuhamen Zena
- Department of Microbiology, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abera Abdeta
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Correspondence: Abera Abdeta, National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian public health institute, P.O. Box:1242, Addis Ababa, Ethiopia, Tel +251911566420, Email
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14
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Ates F, Durmaz MS, Yorulmaz A, Sara HI. Quantitative assessment of bladder wall vascularity index in children with acute cystitis using superb microvascular imaging. J Ultrasound 2022; 25:27-33. [PMID: 33453056 PMCID: PMC8964856 DOI: 10.1007/s40477-020-00549-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in assessment of the anterior urinary bladder wall in pediatric patients with acute cystitis (AC). METHODS The anterior bladder wall of 157 patients (age range 13-84 months, mean 43.62 ± 17.79 months) whose clinical and laboratory findings were proven of AC and 150 healthy asymptomatic participants (age range 13-84 months, mean 43.88 ± 18.11 months) with normal laboratory values were examined using cSMI. VI measurements were performed by manually drawing the contours of the anterior bladder wall using the free region of interest with 2-dimensional cSMI VI (2DcSMIVI) mode. The quantitative 2DcSMIVI values of the symptomatic group and the asymptomatic group were compared. The correlation between the 2DcSMIVI values and the anterior bladder wall thickness (BWT) were analyzed. RESULTS The mean 2DcSMIVI values of the BWT were significantly higher in symptomatic group when compared to the asymptomatic group (p<0.001). AC can be diagnosed with a 93% sensitivity, 92% specificity when 3.25% 2DcSMIVI designated as the cutoff value. There was a significant positive correlation between 2DcSMIVI values and BWT (p<0.001). CONCLUSION Two-dimensional cSMI VI can be used effectively in children as an imaging method in the diagnosis of AC.
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Affiliation(s)
- Fatih Ates
- Department of Radiology, Medicine Faculty, Selçuk University, Konya, Turkey
| | | | - Alaaddin Yorulmaz
- Department of Pediatrics, Medicine Faculty, Selçuk University, Konya, Turkey
| | - Halil Ibrahim Sara
- Departments of Radiology, University of Health Sciences, Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Al-Zubaidi O, Al-Salman A. Assessment of parents’ awareness about urinary tract infections in children of Babylon Province. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Khalatbari H, Shulkin BL, Aldape L, Parisi MT. Pediatric Nuclear Medicine: Technical Aspects. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zaki MES, Eid AE, El-Kazzaz SS, El-Sabbagh AM. Molecular Study of Escherichia albertii in Pediatric Urinary Tract Infections. Open Microbiol J 2021. [DOI: 10.2174/1874285802115010139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
There are insufficient data about the presence of E. albertii as a causative organism in urinary tract infection in pediatric patients. Objective: The present study aimed to detect E. albertii by polymerase chain reaction (PCR) for detection of uidA, mdh, and lysP genes among isolated E.coli from children with urinary tract infection.
Methods:
The present study was a cross-sectional retrograde study which was carried out on 100 isolates of phenotypically confirmed E.coli detected in urine samples of children suffering from urinary tract infection. The isolates were subjected to molecular identification by PCR for uidA, mdh, and lysP genes.
Results:
E. albertii was identified by PCR in 7% of the isolates and E.coli was identified in 93% of the isolates. Two mdh and lysP genes were detected for E. albertii and the uidA gene for E. coli. E. albertii isolates had marked resistance to gentamicin (71.4%), followed by resistance to ciprofloxacin (57.1%), meropenem and imipenem (42.9% each) and ESBL activity by double discs method was reported in 57.1% of the isolates. However, none of the isolates had shown resistance to nalidixic acid and only one isolate had resistance to norfloxacin. There was a statistically insignificant difference between resistance to the used antibiotics such as aztreonam (P=0.083), ampicillin/clavulanate (P=0.5), ciprofloxacin (P=0.69), gentamicin (P=0.3) and ceftazidime (P=1.00).
Conclusion:
The present study highlights the emergence of E. albertii as a pathogen associated with urinary tract infections in children. There is marked antibiotic resistance of this pathogen, especially toward extended spectrum beta-lactams antibiotics. The identification method depends mainly on genetic studies. Further longitudinal studies with large number of patients are required to verify the accurate prevalence of this bacterium.
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Costea RM, Maniu I, Dobrota L, Pérez-Elvira R, Agudo M, Oltra-Cucarella J, Dragomir A, Bacilă C, Banciu A, Banciu DD, Cipăian CR, Crișan R, Neamtu B. Exploring Inflammatory Status in Febrile Seizures Associated with Urinary Tract Infections: A Two-Step Cluster Approach. Brain Sci 2021; 11:1168. [PMID: 34573189 PMCID: PMC8465625 DOI: 10.3390/brainsci11091168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are considered common facilitating factors, along with other infections, in triggering febrile seizures (FS). The main purpose of our study was to identify specific inflammatory patterns of UTI cases from other infections in a specific cluster, using a combination of inflammatory biomarkers to differentiate UTIs from other bacterial diseases triggering FS. METHOD This prospective study included a number of 136 patients with 197 distinct FS events, from patients hospitalized in the Pediatric Clinical Hospital Sibiu, among which 10.2% were diagnosed with UTIs. RESULTS In one-third of the patients with UTIs (20 cases), the symptoms were limited to fever and FS. Using two-step cluster analysis, a distinct UTI inflammatory pattern has emerged: highest platelet values (PLT), median value 331 × 103/mm3 and intermediate C-reactive protein (CRP), median value 15 mg/dL, platelet distribution width (PDW), median value 9.65%, platelet-large cell ratio (P-LCR), median value 14.45%, mean platelet volume (MPV), median value 8.60 fL and neutrophil-to-lymphocyte values (NLR), median value 3.64. Furthermore, higher PDW (median value 12.25%), P-LCR (median value 28.55%), MPV (median value 10.40 fL), CRP (median value 74.00 mg/dL) and NLR values (median value 4.11) were associated mainly (85.7%) with bacterial lower respiratory infections. UTIs were highly unlikely in these patients with significantly increased CRP values and normal values of platelet indices. CONCLUSIONS Considering the nonspecific clinical picture of UTIs at an early age, to optimize the management of FS, a fast diagnosis of UTI is mandatory. The analysis of the inflammatory biomarker clusters (rather than individual parameters) correlated with urine leukocyte and nitrite stick evaluation for specific age groups could help in identifying even oligosymptomatic UTIs patients. The study limitation (20 UTI cases) recommends future multicentric trials on larger datasets to validate the model.
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Affiliation(s)
- Raluca Maria Costea
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Pediatric Neurology Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Ionela Maniu
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Research Center in Informatics and Information Technology, Mathematics and Informatics Department, Faculty of Sciences, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
| | - Luminita Dobrota
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Rubén Pérez-Elvira
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain; (R.P.-E.); (M.A.)
| | - Maria Agudo
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain; (R.P.-E.); (M.A.)
| | - Javier Oltra-Cucarella
- Department of Health Psychology, Universidad Miguel Hernández de Elche, 03202 Elche, Spain;
| | - Andrei Dragomir
- N.1 Institute for Health, National University of Singapore, Singapore 117575, Singapore;
| | - Ciprian Bacilă
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Adela Banciu
- Department of Bioengineering and Biotechnology, Faculty of Medical Engineering, Politechnic University of Bucharest, 011061 Bucharest, Romania; (A.B.); (D.D.B.)
| | - Daniel Dumitru Banciu
- Department of Bioengineering and Biotechnology, Faculty of Medical Engineering, Politechnic University of Bucharest, 011061 Bucharest, Romania; (A.B.); (D.D.B.)
| | - Călin Remus Cipăian
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Roxana Crișan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Bogdan Neamtu
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
- Computer and Electrical Engineering Department, Faculty of Engineering, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
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Schierz JH, Sarikaya I, Albatineh AN, Sarikaya A. Assessing the correlation between 68Ga-PSMA-11 renal PET parameters and renal function tests. J Nucl Med Technol 2021; 50:43-48. [PMID: 34330809 DOI: 10.2967/jnmt.121.262462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: 68Ga -PSMA ligands are used for prostate cancer but also show high renal cortical uptake. In this study, we aimed to assess if there is any correlation between renal PSMA PET parameters and renal function tests using the images of prostate cancer patients. Methods: 68Ga-PSMA-11 PET/CT images of the patients with prostate cancer were retrospectively evaluated. The following PET parameters were obtained: SUVmax, SUVmean, SULmax, SULmean, volume, TLGSUL and counts of both kidneys as well as SUVmean of liver, blood pool and spleen. Total TLGSUL, total volume, kidney to liver and kidney to blood pool ratios were calculated. Patient's creatinine values were obtained and GFR was calculated using the MDRD formula. Statistical analysis was performed to understand if there is a correlation between above parameters and renal function tests. Results: Twenty five patients were included in this study. GFR was significantly/positively correlated and creatinine was significantly/negatively correlated with renal SUV/liver SUV and renal SUV/blood pool SUV ratios. GFR was marginally positively correlated with renal SULmean and creatinine was marginally negatively correlated with total TLGSUL. Total renal parenchymal volume was significantly and directly (positively) associated with GFR and significantly and inversely (negatively) associated with creatinine. Conclusion: Renal 68Ga-PSMA uptake appears to be correlated with renal function tests. Our method of measuring approximate renal parenchymal volume on PET image appears to be reliable.
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20
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Benya EC, Prendergast FM, Liu DB, Wyers MR. Assessment of distal ureteral and ureterovesical junction visualization on contrast-enhanced voiding urosonography. Pediatr Radiol 2021; 51:1406-1411. [PMID: 33576846 DOI: 10.1007/s00247-021-04979-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/20/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Contrast-enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation-free alternative. Analysis of the ureterovesical junction and ureters on VCUG documenting the ureterovesical junction position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomical variations may affect management and surgical approach. OBJECTIVE Our purpose was to assess distal ureteral and ureterovesical junction region visualization in children with VUR detected on CEVUS. MATERIALS AND METHODS CEVUS studies performed between June 2018 and March 2019 with reported VUR were retrospectively reviewed by two pediatric radiologists to confirm VUR and to qualitatively assess the ureterovesical junction region for each renal moiety using a 3-point scale for clear, limited or absent visualization of the distal ureter, ureterovesical junction, ureteral duplication, periureteral diverticula and ureteroceles. RESULTS Thirty-four studies with VUR on CEVUS were identified. Sixty-seven renal moieties were evaluated including a solitary kidney in one child. VUR was detected in 52 moieties by reader 1 and in 53 by reader 2. A single moiety with discrepancy between readers regarding VUR was excluded from statistical analysis. No diverticula were detected by either reader and one ureterocele was detected by both readers. Visualization of the ureterovesical junction was described as clear in 5/52, limited in 14/52 and absent in 33/52 refluxing renal moieties by reader 1 and as clear in 12/52, limited in 20/52 and absent in 20/52 by reader 2. The ureterovesical junction was clearly visualized in 5/52 (9.6%) by reader 1 and 12/52 (23.1%) by reader 2. The Kappa value of -0.29 (confidence interval [CI] -0.25, 0.21) reveals a lack of agreement between the readers for clear versus limited or absent ureterovesical junction visualization. Distal ureteral visualization was described as clear in 14/52, limited in 16/52 and absent in 22/52 refluxing renal moieties by reader 1 and as clear in 27/52, limited in 7/52 and absent in 18/52 by reader 2. The distal ureter was clearly visualized in 14/52 (26.9%) by reader 1 and 27/52 (51.9%) by reader 2. The Kappa of 0.43 (CI 0.22, 0.64) reveals moderate agreement between the readers for clear versus limited or absent distal ureteral visualization. Duplication of the renal collecting system was identified in 13/52 refluxing kidneys by reader 1 and 11/52 refluxing kidneys by reader 2. Visualization of ureteral duplication was described as clear in 9, limited in 4 and absent in 39 of 52 refluxing renal moieties by reader 1 and as clear in 9, limited in 2 and absent in 41 by reader 2. Ureteral duplication was clearly visualized in 9/52 (17.3%) by reader 1 and 9/52 (17.3%) by reader 2. Kappa of 0.87 (CI 0.68, 1) reveals high agreement between the readers for clear versus limited or absent identification of ureteral duplication. CONCLUSION The distal ureter and ureterovesical junction region frequently are not clearly visualized in refluxing renal moieties on CEVUS. Awareness of this limitation is important as there may be implications when evaluating patients for surgical management of VUR.
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Affiliation(s)
- Ellen C Benya
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Francis M Prendergast
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Dennis B Liu
- Department of Urology, Ann & Robert Lurie Children's Hospital, Chicago, IL, USA
| | - Mary R Wyers
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL, 60611, USA
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Albarrak M, Alzomor O, Almaghrabi R, Alsubaie S, Alghamdi F, Bajouda A, Nojoom M, Faqeehi H, Rubeea SA, Alnafeesah R, Dolgum S, ALghoshimi M, AlHajjar S, AlShahrani D. Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2021; 8:57-67. [PMID: 34084874 PMCID: PMC8144855 DOI: 10.1016/j.ijpam.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 10/25/2022]
Abstract
Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Alzomor
- Pediatric Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rana Almaghrabi
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sarah Alsubaie
- Department of Pediatrics, College of medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Faisal Alghamdi
- Pediatric Emergency, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asrar Bajouda
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha Nojoom
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Faqeehi
- Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Subhy Abo Rubeea
- Pediatric Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Alnafeesah
- General Pediatric Department, Alyammamh Hospital, Riyadh, Saudi Arabia
| | - Saeed Dolgum
- Pediatric Infectious Diseases, Dr.Suliman ALhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed ALghoshimi
- General Pediatrics Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami AlHajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dayel AlShahrani
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Sarikaya I, Alqallaf A, Sarikaya A. Renal Cortical 68Ga-PSMA-11 PET and 99mTc-DMSA Images. J Nucl Med Technol 2020; 49:30-33. [PMID: 32887764 DOI: 10.2967/jnmt.120.248922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
68Ga-prostate-specific membrane antigen (PSMA) ligands are novel PET radiotracers for prostate cancer. These radiotracers also localize in the normal renal cortex to a high degree and can demonstrate parenchymal defects. We recently started a prospective research study to compare 68Ga-PSMA-11 PET/CT with 99mTc-dimercaptosuccinic acid (DMSA) scan in adults with pyelonephritis. Here, we present a side-by-side comparison of renal cortical PSMA PET/CT and DMSA images of an adult patient with chronic recurring pyelonephritis. Methods: Our prospective study was approved by the Ethical Committees. DMSA images (multiple planar and SPECT) were obtained 3 h after intravenous injection of 111 MBq (3 mCi) of 99mTc-DMSA. On a separate day, we obtained PET/CT images of the kidneys 60 min after intravenous injection of 74 MBq (2 mCi) of 68Ga-PSMA-11 after the patient provided written informed consent. Results: The patient was a 46-y-old woman with history of chronic recurring pyelonephritis. Both DMSA scan and PSMA PET/CT demonstrated slight cortical thinning with mildly reduced uptake in the upper pole of the right kidney, with no significant cortical defects. There was an excellent distribution of activity in the renal cortex and better image resolution with PSMA PET than with DMSA scan. Non-attenuation-corrected PSMA PET images also showed the same findings, with reasonable image quality. Conclusion: In our first case, 68Ga-PSMA-11 PET imaging provided promising results in an adult patient with pyelonephritis. The results of our prospective study on a larger number of adult patients will provide a more accurate comparison of 68Ga-PSMA-11 PET to 99mTc-DMSA scanning in pyelonephritis.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Ahmed Alqallaf
- Department of Medicine, Division of Nephrology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Guarino S, Capalbo D, Martin N, Campana G, Rambaldi PF, Miraglia Del Giudice E, La Manna A, Marzuillo P. In children with urinary tract infection reduced kidney length and vesicoureteric reflux predict abnormal DMSA scan. Pediatr Res 2020; 87:779-784. [PMID: 31726462 DOI: 10.1038/s41390-019-0676-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of renal ultrasonography (US) in predicting renal uptake defects or reduced renal function at Tc-99m dimercaptosuccinic acid (DMSA) scan (primary outcome). We also evaluated which factors could be associated with Tc-99m DMSA renal scan anomalies. METHODS We retrospectively included all the patients with vesico-ureteral reflux (VUR) undergoing the first Tc-99m DMSA renal scan within 3 months from the most recent renal US between 2016 and 2018. RESULTS Sensitivity, specificity, PPV, and NPV of US in predicting abnormal Tc-99m DMSA scan were 38.9%, 91.5%, 71.9%, and 72.9%, respectively. Different length between the kidneys, expressed as standard deviation score (SDS), showed an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60-0.80; p < 0.0001) when evaluated as predictor of abnormal Tc-99m DMSA scan. A different length between the two kidneys >1.11 SDS had 91.5% sensitivity and 57.6% specificity. At multivariate analysis, the factors with significantly increased odds ratio of abnormal Tc-99m DMSA scan were difference in length between two kidneys >1.11 SDS and dilated VUR. CONCLUSIONS The Tc-99m DMSA scan remains the gold standard to detect renal parenchymal anomalies. A different length between the kidneys >1.11 SDS and dilated VUR are predictors of abnormal Tc-99m DMSA renal scan.
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Affiliation(s)
- Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Daniela Capalbo
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Nunzia Martin
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Giuseppina Campana
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Pier Francesco Rambaldi
- Department of Radiological Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy.
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Leung AK, Wong AH, Leung AA, Hon KL. Urinary Tract Infection in Children. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2019; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K.C. Leung
- Address correspondence to this author at the Department of Pediatrics, the University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada; Tel: (403) 230 3300; Fax: (403) 230 3322; E-mail:
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