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Tu J, Lin T, Li H, Chen C. Acute Focal Bacterial Nephritis without Pyuria: A Peculiar Subtype of Urinary Tract Infection. Pediatr Infect Dis J 2024:00006454-990000000-00940. [PMID: 38986009 DOI: 10.1097/inf.0000000000004469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Acute focal bacterial nephritis (AFBN) without pyuria is a subtype of urinary tract infection in children, often leading to diagnostic challenges. The clinical characteristics of 6 children diagnosed with AFBN, who exhibited an absence of pyuria, were retrospectively summarized and compared with the control group consisting of 49 hospitalized AFBN children with pyuria. The cases of AFBN without pyuria presented with more severe inflammatory responses and were predisposed to complications, such as sepsis and neurological abnormalities.
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Affiliation(s)
- Juan Tu
- From the Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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Aydin O, Karademir S, Bülbül M. Evaluating the requirement of ultrasonography for children with their first urinary tract infection. J Pediatr Urol 2024; 20:504-512. [PMID: 37932198 DOI: 10.1016/j.jpurol.2023.10.026] [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: 06/26/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Management of urinary tract infection (UTI) in children remains important. It may be the first sign for a possible underlying congenital abnormalities for the kidney and urinary tract (CAKUT). This study examined whether performing renal and bladder ultrasonography (RBUS) only for children who have a pathogen other than E. coli during their first urinary tract infection (UTI), or who experience UTI recurrence, would result in more missed diagnoses of kidney anomalies. METHODS Patients aged between 2 months and 2 years who were seen in a tertiary pediatric hospital during a 2-year period and diagnosed with UTI were included. RBUS and voiding cystourethrography (VCUG) were performed according to American Academy of Pediatrics (AAP) guidelines. Afterwards, we looked back and evaluated how often we found kidney problems when we only did a RBUS on patients who had an atypical cause of their first UTI or who had multiple UTIs. RESULTS One hundred and seventy-eight patients who were followed up with UTI were included in this study. The isolated pathogen was E. coli in 104 cases (58.4 %) and atypical in 74 cases (41.6 %). VCUG was conducted on 40 patients, and vesicoureteral reflux (VUR) was discovered in 16 cases and ureteropelvic junction obstruction (UPJO) was discovered in 1 case. A different diagnostic approach that required the presence of an atypical pathogen at the first UTI or a fUTI recurrence to perform the RBUS would have missed just two severe kidney anomalies. It was observed that there could be a decrease of 40.4 % in RBUS and at least 20 % in VCUG. CONCLUSIONS A diagnostic approach that necessitates the presence of an abnormal pathogen during the initial UTI or a second UTI episode for the RBUS to be carried out would lead to fewer negative ultrasounds with minimal risk of overlooking kidney anomalies.
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Affiliation(s)
- Orkun Aydin
- Department of Pediatrics, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Selmin Karademir
- Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Bülbül
- Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
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Chou HH, Huang LC, Shen SP, Tsai ML, Chang YC, Lin HC. Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection. Sci Rep 2024; 14:9520. [PMID: 38664452 PMCID: PMC11045864 DOI: 10.1038/s41598-024-59943-2] [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] [Received: 10/07/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11-1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.
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Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Lin-Chih Huang
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shang-Po Shen
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Ming-Luen Tsai
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Road., Wufeng, Taichung, 41354, Taiwan.
- Department of Long-Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan.
| | - Hung-Chi Lin
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Asia University Hospital, Asia University, Taichung, Taiwan.
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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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Neto A, Sage H, Patel AK, Rivera-Sepulveda A. Antibiotic Stewardship and Treatment of Uncomplicated Urinary Tract Infection (UTI) in Children and Adolescents in the Emergency Department of a Community Hospital. Clin Pediatr (Phila) 2024; 63:357-364. [PMID: 37226473 PMCID: PMC11060847 DOI: 10.1177/00099228231175471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A retrospective, cross-sectional study of children with suspected urinary tract infections (UTIs) 3 months to 18 years of age who had a urinalysis and urine culture (UC) during an emergency department (ED) visit between 2019 and 2020 was performed. Chi-square, Fisher exact, and independent samples T tests were used as appropriate. Median age was 6.6 years (interquartile range = 3.3-12.4). Urinalysis positivity was 92.8%, of which 81.9% of children were prescribed a first-line antibiotic. First-line antibiotic use was 82.7%. Positive UC rate was 84.7%, with 84% receiving a first-line antibiotic (P = .025). The correlation between a positive urinalysis and a positive UC was 80.8% (P < .001). Change of antibiotics based on the uropathogen of positive UCs was 6.3% (P < .001). The urinalysis and UC guided the diagnosis and treatment of UTIs. First-line antibiotics can be safely administered in the ED and prescribed for positive urinalyses. Studies are needed to evaluate the discontinuation of antibiotics with negative UCs as part of antibiotic stewardship initiatives.
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Affiliation(s)
- Arino Neto
- Department of Pediatrics, Nemours Children's Health, Orlando, FL, USA
| | - Hannah Sage
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Amit K Patel
- Division of Emergency Medicine and Urgent Care, Nemours Children's Health, Orlando, FL, USA
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Vaezipour N, Evers K, Schmid H, Ritz N, Goischke A. Is shorter antibiotic treatment duration increasing the risk of relapse in paediatric acute focal bacterial nephritis? Arch Dis Child 2024; 109:248-250. [PMID: 37949642 DOI: 10.1136/archdischild-2023-326054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Nina Vaezipour
- Department of Paediatric Infectious Diseases and Vaccinology, University Childrens Hospital Basel, Basel, Switzerland
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
| | - Katrina Evers
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
| | - Hanna Schmid
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
- Department of Paediatrics and Paediatric Infectious Diseases, Childrens Hospital Lucerne and Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, The Royal Childrens Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Goischke
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
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Guo BC, Chen CY, Huang WY, Lin WY, Chen YJ, Lee TA, Lin MJ, Wu HP. Risk Factors for Urinary Tract Infections in Children with Hematuria in the Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:248. [PMID: 38397360 PMCID: PMC10887536 DOI: 10.3390/children11020248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Hematuria is a worrisome symptom in children and is sometimes associated with urinary tract infections (UTIs). This study aimed to identify useful clinical factors that can predict UTIs in hematuria patients without pyuria in the pediatric emergency department (ED). METHODS We retrospectively recruited patients with hematuria from the pediatric ED. Clinical symptoms, urine biochemistry and microscopic examination results, and blood laboratory tests were analyzed to identify the predictors of UTIs. Patients were divided into the verbal group (age ≥ 2 years) and non-verbal group (age < 2 years) for identifying predictors of UTIs. Causes of hematuria were also investigated. RESULTS A total of 161 patients with hematuria without pyuria were evaluated. Among symptoms, dysuria was significantly correlated with UTIs. Regarding urine biochemistry data, urine esterase and urine protein > 30 mg/dl were found to be significant parameters for predicting UTIs, while urine esterase and urine nitrite showed significant differences in children with age < 2 years. In the urine microscopic examinations, urine red blood cells (RBC) > 373/µL in children aged ≥ 2 years and urine RBC > 8/µL in children aged < 2 years were associated with UTIs. In addition, UTIs and urinary tract stones were found to be the top two causes of hematuria. CONCLUSIONS Dysuria, urine esterase, urine nitrite, and urine protein may be useful parameters for predicting UTIs in pediatric patients with hematuria but no pyuria in the ED. In addition, a UTI was the most commonly identified etiology of hematuria without pyuria, followed by urinary tract stones.
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Affiliation(s)
- Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs’ Taichung MetroHarbor Hospital, Taichung 43503, Taiwan;
| | - Wun-Yan Huang
- Department of Pediatric Emergency Medicine, China Medical University Children’s Hospital, Taichung 40447, Taiwan;
| | - Wen-Ya Lin
- Department of Pediatrics, Taichung Veteran General Hospital, Taichung 43503, Taiwan;
| | - Ying-Ju Chen
- Department of Rehabilitation, New Tai Ping Cheng Ching Hospital, Taichung 41142, Taiwan;
| | - Tai-An Lee
- Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 50544, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97002, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Straus Takahashi M, Gustavo Ieiri Yamanari M, Henrique de Marqui Moraes P, Lopes RI, Chammas MC. Vesicoureteral reflux by contrast ultrasound, comparison with voiding and retrograde urethrocystography: A prospective accuracy study. J Pediatr Urol 2024; 20:133.e1-133.e9. [PMID: 37925278 DOI: 10.1016/j.jpurol.2023.10.014] [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: 12/01/2022] [Revised: 05/29/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Diagnosis of vesicoureteral reflux (VUR) plays an important role in the management and follow-up of children presenting with urinary tract infection. This study compared voiding uronosography (VUS) as a diagnostic method for the diagnosis of VUR with the "gold standard", voiding or micturating cystourethrography (MCU). The objective of the study is not only to compare the effectiveness of both methods, but also to assess the feasibility of implementing VUS technically and economically in a large tertiary radiology center in South America. MATERIALS AND METHOD This was a prospective accuracy study that include 41 patients (a total of 85 ureteral units) aged between 1 month and 16 years. VUS was performed in an alternative form as regular MCU, by injecting microbubble contrast solution (SonoVue©) into the bladder through an intermittent catheter and evaluating the presence of reflux with ultrasound. MCU was always performed immediately after VUS. One pediatric radiologist evaluated all VUS exams, while a second independent pediatric radiologist evaluated all MCU exams, with both blinded to each other's assessments. RESULTS Comparing VUS with MCU in the diagnosis of VUR, we observed a sensitivity of 92.3 % (95 % CI 74.9-99.1 %), specificity of 98.3 % (95 % CI 90.9-100 %), positive predictive value of 96.0 % (95 % CI 79.6-99.9 %), negative predictive value of 96.7 % (95 % CI 88.5-99.6 %) and a Kappa of 0.916 (0.822-1.000). When comparing the VUR grading between VUS and MCU the agreement between the two methods was high with a Kendall's Tau-b > 0.9. VUS failed to diagnose two grade 1 VUR reflux cases in teenagers while diagnosing one grade 4 VUR in a very dilated kidney-ureter unit, which was missed on MCU. VUS and MCU had similar costs when considering the price of the ultrasound contrast agent. DISCUSSION VUS is a reliable alternative method to MCU for the diagnosis of VUR with the advantages of not exposing the child to ionizing radiation and potentially being more accessible due to the greater availability of ultrasound equipment. Limitations to this study include the usage of a single ultrasound equipment, which limits its generalizability and not evaluating the interobserver variability. CONCLUSION Consideration should be given to implementing VUS for the diagnosis of VUR, particularly in centers without fluoroscopy equipment available, since the exam's performance and cost are comparable to those of the MCU.
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Affiliation(s)
- Marcelo Straus Takahashi
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
| | - Mauricio Gustavo Ieiri Yamanari
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil; Hospital de Cancer Infanto-juvenil de Barretos, Barretos, SP, Brazil
| | - Pedro Henrique de Marqui Moraes
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Roberto Iglesias Lopes
- Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Maria Cristina Chammas
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Carl C, Dinkelbach L, Mohr J, Perez R, Vera Lopez T, Fricke-Otto S, Niehues T. Case report: Life threatening hyponatremia in infants with urinary tract infections: two cases of type III pseudohypoaldosteronism and review of the literature. Front Pediatr 2024; 11:1233205. [PMID: 38250595 PMCID: PMC10797885 DOI: 10.3389/fped.2023.1233205] [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: 06/01/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
We describe two female infants at the age of five and six months with urinary tract infections presenting with vomiting and reduced drinking behavior. On laboratory analysis, severe hyponatremia (106 mmol/L and 109 mmol/L) was seen with hyperkalemia and compensated metabolic acidosis. Endocrinological analyses revealed massively increased levels of aldosterone and renin, leading to the diagnosis of type III pseudohypoaldosteronism (PHA). A review of the current literature 2013-2023 revealed 26 type III PHA cases aged up to ten months with reduced drinking behavior, weight loss and/or failure to thrive being the most common clinical presentations. Given the severe presentation of PHA electrolyte measurements in infants with urinary tract infections and/or in infants with congenital anomalies of the kidney and urinary tract (CAKUT) are strongly recommended.
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Affiliation(s)
- Cécile Carl
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
- Medical Faculty, RWTH University Aachen, Aachen, Germany
| | - Lars Dinkelbach
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
- Department of Pediatrics III, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Julia Mohr
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ruy Perez
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Tobias Vera Lopez
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Susanne Fricke-Otto
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Tim Niehues
- Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Krefeld, Germany
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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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Gulyuz A, Tekin M. The Diagnostic Efficacy of and Requirement for Postnatal Ultrasonography Screening for Congenital Anomalies of the Kidney and Urinary Tract. Diagnostics (Basel) 2023; 13:3106. [PMID: 37835849 PMCID: PMC10572234 DOI: 10.3390/diagnostics13193106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We aimed to investigate the efficacy of postnatal ultrasonography in detecting congenital anomalies of the kidneys and urinary tract in term infants without prenatal history of congenital anomalies of the kidneys and urinary tract. METHODS In this retrospective cohort study, we reviewed the records of term infants between six weeks and three months of age who underwent urinary tract ultrasonography during routine pediatric care. RESULTS Congenital anomalies of the kidneys and urinary tract were detected on prenatal ultrasonography in 75 of the 2620 patients included in the study. Congenital anomalies of the kidneys and urinary tract were detected via postnatal USG in 46 (1.8%) of 2554 patients without anomalies on prenatal USG screening. The most common anomaly was hydronephrosis (69.6%). Thirty-two cases of hydronephrosis, three cases of renal agenesis, four cases of horseshoe kidney, one case of MCDK, and two cases of duplex systems which were not detected on prenatal USG were detected on postnatal USG. On the other hand, 29 (1.1%) cases with mild or moderate hydronephrosis on prenatal ultrasonography did not have hydronephrosis on postnatal ultrasonography. CONCLUSIONS In our study, approximately one-third of the cases of hydronephrosis, unilateral renal agenesis, duplex systems, horseshoe kidney, and ectopic kidney were not detected in prenatal ultrasonography screening. Therefore, we believe that in addition to prenatal ultrasonography screening, postnatal ultrasonography screening of all children for urinary tract anomalies would be beneficial.
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Affiliation(s)
- Abdulgani Gulyuz
- Department of Pediatrics, School of Medicine, Turgut Ozal University, 06560 Malatya, Turkey;
| | - Mehmet Tekin
- Department of Pediatrics, School of Medicine, Inonu University, 44280 Malatya, Turkey
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Lee MM, Briars L, Ohler KH, Gross A, Oliveri LM. Evaluation of Outpatient Antibiotic Prescribing for Urinary Tract Infection in Pediatric Patients Ages 2 Months to 18 Years. J Pediatr Pharmacol Ther 2023; 28:241-246. [PMID: 37303772 PMCID: PMC10249974 DOI: 10.5863/1551-6776-28.3.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To characterize the diagnosis and management of urinary tract infection (UTI) in pediatric patients at the University of Illinois Hospital and Health Sciences System (UIH), with an emphasis on antibiotic prescribing; in addition, to characterize pediatric uropathogen patterns to help guide future empiric therapy choices. METHODS We used a retrospective, descriptive study of pediatric patients ages 2 months to ≤18 years seen at the UIH emergency department or clinic from January 1, 2014, to August 31, 2018, with ICD-9 or ICD-10 discharge diagnosis of UTI. Data collected included presenting symptoms, urinalysis, details of antibiotic regimens, urine culture, and susceptibility results. RESULTS Of the 207 patients included, the median age was 5.7 years (IQR, 3.2-9.4), and 183 patients (88.4%) were female. Common symptoms included dysuria (57%) and fever (37%). Empiric antibiotics were p-rescribed in 96.1% of cases, most commonly cefdinir (42%), cephalexin (22%), and sulfamethoxazole-trimethoprim (14%). Urine cultures were collected in 161 patients (77.8%), with 81 growing >50,000 colony-forming units bacteria. Escherichia coli was the most commonly isolated organism (82.1%), showing susceptibility to third-generation cephalosporins (97%), nitrofurantoin (95%), and sulfamethoxazole-trimethoprim (84%). Although 25 urine cultures showed no growth, antibiotics were discontinued in only 4 cases. CONCLUSIONS Pediatric patients with UTI symptoms were often empirically prescribed cefdinir, possibly an unnecessarily broad choice because many E coli isolates were susceptible to narrower agents. Both urinalysis and urine cultures should be obtained during the diagnostic evaluation of UTI, with better follow-up of negative cultures to potentially discontinue antibiotics. This study highlights areas for improvement in the diagnosis, treatment, and antimicrobial stewardship in pediatric UTI.
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Affiliation(s)
- Michelle M Lee
- Department of Pharmacy (MML), Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Leslie Briars
- Department of Pharmacy (LB, KHO, AG, LMO), University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Kirsten H Ohler
- Department of Pharmacy (LB, KHO, AG, LMO), University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Alan Gross
- Department of Pharmacy (LB, KHO, AG, LMO), University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Lauren M Oliveri
- Department of Pharmacy (LB, KHO, AG, LMO), University of Illinois at Chicago College of Pharmacy, Chicago, IL
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Meštrović Popovič K, Povalej Bržan P, Langerholc T, Marčun Varda N. The Impact of Lactobacillus Plantarum PCS26 Supplementation on the Treatment and Recurrence of Urinary Tract Infections in Children-A Pilot Study. J Clin Med 2022; 11:jcm11237008. [PMID: 36498583 PMCID: PMC9736295 DOI: 10.3390/jcm11237008] [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: 10/05/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Urinary tract infections (UTI) are frequent bacterial infections in childhood. Considering the known beneficial effects of probiotics in the gastrointestinal field, they could also help to alleviate UTIs. In our clinical pilot study, we sought to verify the positive effects of the specific probiotic strain on the course and prevention of UTI in children. Thirty children with UTIs were enrolled and sequentially sampled into two groups (placebo/control and probiotic/test) in a double-blind, randomized, placebo-controlled clinical pilot study. We chose Lactobacillus plantarum PCS 26 (Lp26) derived from local Slovenian cheese in Pathogen Combat Project, which showed a good in vitro antimicrobial effect on Escherichia coli (E. coli). Several parameters were followed to look for differences between both groups in the acute phase of the UTI and after 6 months of taking probiotic or placebo supplementation. Our results showed no statistically significant differences between both groups; however, two children in the placebo group suffered a recurrence of febrile UTI within 6 months of the follow-up period, while there were no recurrences of UTI in the probiotic group. In the test group, the number of febrile days after the initiation of antibiotics with probiotics was shorter, although not reaching statistical significance (p = 0.084). According to our results, probiotics might be helpful in alleviating UTI symptoms and in UTI prevention. Further research with a larger sample size is warranted. Additionally, basic scientific studies for the selection of proper immunobiotic strains of probiotics should be performed.
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Affiliation(s)
- Katarina Meštrović Popovič
- General Hospital Celje, Oblakova 5 (omit Splošna bolnišnica Celje), SI-3000 Celje, Slovenia
- Correspondence: ; Tel.: +386-34233504
| | - Petra Povalej Bržan
- Faculty of Medicine, University of Maribor, Taborska ulica 8, SI-2000 Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, SI-2000 Maribor, Slovenia
| | - Tomaž Langerholc
- Department of Microbiology, Biochemistry, Molecular Biology and Biotechnology, Faculty of Agriculture and Life Sciences, University of Maribor, Pivola 10, SI-2311 Hoče, Slovenia
| | - Nataša Marčun Varda
- Department of Pediatrics, University Medical Centre Maribor, Ljubljanska cesta 2, SI-2000 Maribor, Slovenia
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Comparative study of open, laparoscopic and endoscopic treatments of intermediate grade vesicoureteral reflux in children. Surg Endosc 2022; 37:2682-2687. [PMID: 36414870 DOI: 10.1007/s00464-021-08985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low-grade vesicoureteral-reflux (VUR) are rather treated by endoscopic injection, whereas open or laparoscopic procedures are mainly performed for high-grade VURs. Management of intermediate grades is controversial and no study focused on grade III to date. This study aims to compare the results of open, laparoscopic, and endoscopic approaches in children with grade III VUR. METHODS A multicenter comparative retrospective study included children with grade III VUR operated for febrile urinary tract infections (UTIs) from 2007 to 2016. Children without UTI, with reflux of other grades, neurological bladder, duplex system, posterior urethral valves, and bladder exstrophy were excluded. Success was defined as no recurrence of febrile UTI and was presented as event-free survival curves. RESULTS Out of 806 children operated of VUR, 171 met the inclusion criteria (114 females). Seventy-seven children (45%) underwent an open Cohen procedure, 35 (21%) a laparoscopic Lich-Gregoir and 59 (34%) a submucosal endoscopic injection according to the centers' preference. The mean follow-up was 64 months (24-132). Groups were not different for age, sex, and circumcision status. Compared to Cohen procedure, recurrences of febrile UTI were more frequent after laparoscopic treatment (p = 0,02, 8/35) and endoscopic treatment (p = 0.001, 16/59). Redosurgery was also more frequent after laparoscopy (n = 2) and endoscopic injection (n = 14) than after open surgery (n = 0, p < 0.001). CONCLUSION Recurrent febrile UTIs and redosurgery are more frequent after endoscopic and laparoscopic procedures in grade III VUR than open reimplantation. Whether the lower morbidity of laparoscopic or endoscopic approaches balances the risk of recurrent febrile UTI remains to be determined for intermediate grade reflux.
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Comparison between Short Therapy and Standard Therapy in Pediatric Patients Hospitalized with Urinary Tract Infection: A Single Center Retrospective Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111647. [PMID: 36360375 PMCID: PMC9688884 DOI: 10.3390/children9111647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
Introduction: There is marked heterogeneity in clinicians’ choice of antibiotic duration for pediatric urinary tract infections (UTIs). Most patients with bacterial UTIs still receive between 7 and 10 days of antibiotics. Prolonged antibiotic exposure drives the emergence of resistance and increases the occurrence of adverse effects. There is increasing evidence that shorter antibiotic regimens may be equally effective compared with longer ones. However, studies evaluating shorter therapies in children hospitalized with urinary tract infections have not yet been performed. Methods: We performed a retrospective study comparing children hospitalized with UTIs treated with a short antibiotic (<7 days) or standard antibiotic treatment. The primary aim of our study was to assess the efficacy of a shorter antibiotic therapy for children with UTIs, compared with an historical group of children treated with a standard 7−14 days course. Results: 112 patients, 46 of which were females (41.1%) with a median age 6 months were enrolled. A total of 33 patients (29.5%) underwent a short therapy. All patients were successfully discharged from the acute episode, independently from antibiotic duration. Short therapy was associated with a lower risk of urinary tract relapse (22 relapses (95.6%) in the standard group, 1 (4.4%) in the short group; OR 0.081; 95%CI 0.01−0.63). Conclusions: Short antibiotic therapy was equivalent to standard duration therapy for the cure of UTIs in hospitalized children and was also associated with a lower rate of recurrences. This study provides the basis for a larger prospective randomized study to address the role of short antibiotic therapies in children with UTIs requiring hospitalization
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Horsager TH, Hagstrøm S, Skals R, Winding L. Renal scars in children with febrile urinary tract infection - Looking for associated factors. J Pediatr Urol 2022; 18:682.e1-682.e9. [PMID: 36253233 DOI: 10.1016/j.jpurol.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Febrile urinary tract infection (UTI) is a common childhood infection related to renal scarring and potentially long-term complications like chronic kidney disease. It would be of great benefit to find a correlation between easy-accessible factors in the acute phase of a febrile UTI and the development of renal scar formation and/or decreased renal function in order to identify children at risk of future complications. OBJECTIVE The aim of this study was to identify factors associated with the development of decreased split renal function (DSRF) and/or permanent renal scar formation in children with febrile UTI. STUDY DESIGN The medical records of 212 Children aged 0 months to 15 years with febrile UTI admitted to The Pediatric Department of Lillebaelt Hospital, Kolding from January 2011 to September 2014 were systematically reviewed. We analyzed clinical, laboratory, and radiologic findings. Statistical analysis was performed to identify factors associated with renal scar formation and DSRF on nuclear imaging at 6 months follow-up. RESULTS A total of 113 medical records were eligible for further analysis, 99 girls and 14 boys, 34 patients younger than 12 months. In total 30 patients (26.5%) had an abnormal follow-up imaging (DSRF less than 45% and/or renal scarring). Nine patients (8%) had renal scarring. Four patients (3.5%) had renal scarring only, 21 patients (18.6%) had DSRF only, and five patients (4.4%) had both renal scarring and DSRF. Patients with renal scar formation on follow-up imaging had significantly higher C-reactive protein (CRP) than patients with no scarring (p < 0.01). CRP and absolute neutrophil count (ANC) was significantly higher in patients with abnormal follow-up imaging (p < 0.01 and p = 0.010), and these patients more often had positive nitrite in urine dipstick compared to patients with normal kidneys on follow-up (p = 0.048). Temperature above 38.5 °C and CRP >50 mg/L in combination were also associated with a higher risk of abnormal follow-up imaging (p = 0.016). DISCUSSION This study contributes with further knowledge to the ongoing debate regarding renal scarring but also reveals the possibility of associated factors for the development of DSRF following a febrile UTI in children. However, due to the retrospective design as well as the small number of events in our study definite conclusions on whether the above-mentioned factors are indeed prognostic for the development of renal scarring or DSRF following a febrile UTI can not be drawn.
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Affiliation(s)
- Tanja Hübertz Horsager
- Department of Paediatrics and Adolescence Medicine, Lillebaelt Hospital Kolding, Kolding, Denmark.
| | - Søren Hagstrøm
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Regitze Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Louise Winding
- Department of Paediatrics and Adolescence Medicine, Lillebaelt Hospital Kolding, Kolding, Denmark
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Agrawal T, Tk J, Rathod K, Pathak M, Sinha A. Correspondence to the article 'risk of urinary tract infection in patients with hydroureter: an analysis from the society of fetal urology prenatal hydronephrosis registry'. J Pediatr Urol 2022; 18:722-723. [PMID: 36008201 DOI: 10.1016/j.jpurol.2022.07.031] [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: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Tripti Agrawal
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
| | - Jayakumar Tk
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kirtikumar Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Management of Pediatric Urinary Tract Infections: A Delphi Study. Antibiotics (Basel) 2022; 11:antibiotics11081122. [PMID: 36009990 PMCID: PMC9404756 DOI: 10.3390/antibiotics11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.
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Ultrasonography Results in First Urinary Tract Infection During Childhood: Which Age Group Should Be Screened? Indian J Pediatr 2022:10.1007/s12098-022-04213-0. [PMID: 35771350 DOI: 10.1007/s12098-022-04213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To determine the frequency of urinary system anomaly in children aged 0-18 y suffering from first urinary tract infection (UTI) and to establish which age group requires urinary ultrasonography (USG) screening. METHODS Age and gender, urine culture, urinary USG, and urological imaging results among 247 children in the 0-18 y age group with a first diagnosis of UTI were investigated retrospectively. RESULTS Anomaly was detected at USG in 68 (27.5%) of the 247 patients suffering from first UTI. The most common anomaly was hydronephrosis. Non-E. coli micro-organisms were the pathogenic agents in 61.8% of patients with anomalies detected at USG. Being in the 0-5 y age group (OR: 0.524, 95% CI 0.284-0.970, p = 0.040) and presence of atypical UTI (OR: 4.746, 95% CI: 1.675-13.450, p = 0.003) emerged as independent predictive markers of severe urinary system pathologies on multiple regression analysis. CONCLUSION Based on the data in the present study, routine USG screening is recommended for children suffering from first UTI under the age of 5 y and for the children suffering from atypical UTI at all ages.
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Bagnasco F, Piaggio G, Mesini A, Mariani M, Russo C, Saffioti C, Losurdo G, Palmero C, Castagnola E. Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance. Antibiotics (Basel) 2022; 11:antibiotics11060720. [PMID: 35740127 PMCID: PMC9220059 DOI: 10.3390/antibiotics11060720] [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: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007−December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.
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Affiliation(s)
- Francesca Bagnasco
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Correspondence:
| | - Giorgio Piaggio
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy;
| | - Carolina Saffioti
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Giuseppe Losurdo
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Candida Palmero
- Clinical Pathology Laboratory and Microbiology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
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M Diaz Kane M. Diagnosing and Treating Urinary Tract Infections in the Outpatient Setting. Pediatr Ann 2022; 51:e175-e177. [PMID: 35575543 DOI: 10.3928/19382359-20220314-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urinary tract infection (UTI) is a common diagnosis that brings children to seek medical care. It is the second most common bacterial infection in children after otitis media. However, diagnosing UTIs can be challenging, particularly in younger children, given that the symptoms may be nonspecific and it may be logistically difficult to obtain an appropriate urine sample. Importantly, if not correctly identified and treated, infections of the urinary tract can lead to complications, including renal scarring, hypertension, and chronic kidney disease. Thus, it is critical for pediatric providers to recognize, diagnose, and treat UTI appropriately. This article aims to provide a general overview of the risk factors for UTI as well as a practical approach to diagnosing and treating UTIs in children in the outpatient setting. [Pediatr Ann. 2022;51(5):e175-e177.].
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22
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Comparison of infants and children with urolithiasis: a large case series. Urolithiasis 2022; 50:411-421. [PMID: 35482085 DOI: 10.1007/s00240-022-01327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 ± 35 months (0.4-231 months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3 mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12 months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF ( - ) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease.
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Correlation of Renal Scarring to Urinary Tract Infections and Vesicoureteral Reflux in Children. Adv Urol 2022; 2022:9697931. [PMID: 35529476 PMCID: PMC9072046 DOI: 10.1155/2022/9697931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To study the association of the grade of vesicoureteral reflux (VUR) and urinary tract infections (UTI) with renal scarring at the first clinical presentation of patients who underwent antireflux surgery. Materials and methods. Between 2015 and 2020, 150 patients (194 units) who underwent antireflux surgery had dimercaptosuccinic acid (DMSA) renal scans preoperatively. Patients were classified into the nonscar and scar groups according to DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of VUR to the presence/absence of renal scars in both groups. Results The mean follow-up was 45 months preoperatively. The mode of presentation was afebrile, febrile UTIs, and antenatal hydronephrosis in (50, 14), (20, 46), and (10, 10) patients in the nonscar and scar groups, respectively. Of the 20 patients who presented ANH, 10 (50%) had scars. Clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of VUR than the nonscar group (grades I–II (50 units versus 10 units), grade III (28 units versus 40 units), and grade IV–V (22 units versus 44 units) for the nonscar versus scar groups, respectively (pvalue <0.001). Conclusion Renal scarring is associated with higher grades of reflux and urinary tract infections. We advocate further research investigating infants who had UTIs with or without fever for early detection of reflux.
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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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A quantitative sensing system based on a 3D-printed ion-selective electrode for rapid and sensitive detection of bacteria in biological fluid. Talanta 2022; 238:123040. [PMID: 34801897 DOI: 10.1016/j.talanta.2021.123040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
Bacterial infections, such as urinary tract infections, are crucial health problems. Here, we report a new potentiometric sensor to detect bacteria sensitively, accurately, and quickly. First, a customizable, 3D printed Ag+ selective electrode was fabricated as the probe. Our 3D printed electrode showed sensitive, linear, and selective responses to Ag+. Compared to commercial Ag+ selective electrodes, ours required less sample volume, shorter responding time, and lower costs. Next, a novel potentiometer was developed with Arduino to couple the electrode for data transducing and transferring, which was programmed to transfer results to cell phones wirelessly. Moreover, a filter was designed to quickly remove interfering species in a biofluid sample (e.g., Cl-). By detecting the lost Ag+ taken by bacteria, the bacterial number could be elucidated. With this sensor system, bacteria numbers could be detected as low as 80 CFU/mL (LOD) within 15 min, which is sufficient for many diagnoses (e.g., urinary tract infection >1000 CFU/mL). An amplification method was presented for single-digit bacteria detection. Overall, we are presenting a bacteria detector with three innovative components: the electrode (signal transduction and detection), the potentiometer (transducer and data processing), and the 3D printed filter (sample preparation), which showed robust and improved (than previously reported ones) analytical merits. The low-cost and customizable (the electrode and the open-source coding) nature enhances the transnationality of the system, especially in underdeveloped areas.
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Outpatient and oral management is suitable for infants 60-90 days old with urinary tract infections at low risk of bacteremia. Eur J Pediatr 2022; 181:671-677. [PMID: 34519852 DOI: 10.1007/s00431-021-04224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
One previous study recommended oral and outpatient management for those infants aged 60-90 days with urinary tract infection (UTI) meeting the low-risk criteria identified: to be well-appearing and to have a procalcitonin value of < 0.7 ng/mL. A retrospective study was conducted, including infants aged 29 to 90 days with UTI from 2014 to 2019, to validate these low-risk criteria identified and determine the adherence to the new algorithm for managing these patients at the Emergency Department. Two hundred one patients were included; 105 (52.2%) were aged 60 to 90 days. Twelve (6%, 95% CI 3.4-10.1%) had bacteremia. One hundred thirty-six (67.7%) infants met low-risk criteria; none had a positive blood culture (0%, 95% CI 0-2.7%). Overall protocol adherence was 90.6%. One hundred and forty-four (71.6%) infants were admitted to the hospital; all patients meeting high-risk criteria were hospitalized. Among the 57 (28.4%) infants initially sent home, 4 (7.0%) required later hospital admission.Conclusions: A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants. What is Known: • Patients under 2-3 months of age with a presumptive urinary tract infection (UTI) are commonly hospitalized because of concerns regarding concomitant bacteremia. What is New: • A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.
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Lu J, Liu X, Wei Y, Yu C, Zhao J, Wang L, Hu Y, Wei G, Wu S. Clinical and Microbial Etiology Characteristics in Pediatric Urinary Tract Infection. Front Pediatr 2022; 10:844797. [PMID: 35463882 PMCID: PMC9021593 DOI: 10.3389/fped.2022.844797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common occurrence in children. UTI and urological malformations are intimately linked. However, whether urinary tract malformations affect the clinical features of pediatric UTI remains unclear. The purpose of this study was to characterize the clinical features and microbial etiology of UTI in children. METHODS We retrospectively reviewed the records of 741 patients with UTI treated at the Chongqing Medical University Affiliated Children's Hospital between 2015 and 2020. Patients with and without urological malformations were compared using propensity score matching (PSM). RESULTS Escherichia coli was the most common causative microorganism of UTI, accounting for 40.5% of infections. One hundred twenty-two patients (16.5%) had urological malformations. PSM identified 122 matched pairs of patients with or without urological malformations. The proportion of patients with UTI caused by atypical microorganisms was significantly higher in patients with urological malformations (P = 0.048). Children with urological malformations showed longer duration of intravenous antibiotic treatment (P = 0.010), higher cost of treatment (P < 0.001), and higher prevalence of recurrence (23.8 vs. 10.7%, P < 0.001), compared with the normal group. CONCLUSION Children with urological malformations are more likely to develop UTI with atypical microorganisms. Appropriate imaging examination and urine culture are strongly recommended for the diagnosis and management of pediatric UTI.
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Affiliation(s)
- Jiandong Lu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wei
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengjun Yu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Zhao
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Wang
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Hu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guanghui Wei
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shengde Wu
- Department of Urology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Children's Hospital of Chongqing Medical University, Chongqing, China
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Zhao R, Long X, Wang J, Zhu J, Liu C, Shang T, Zhang Z, Obi E, Osadebe L, Kang Y, Liu J, Chen X, Xu H. Effectiveness of ertapenem for treatment of infections in children: An evidence mapping and meta-analysis. Front Pediatr 2022; 10:982179. [PMID: 36324821 PMCID: PMC9620802 DOI: 10.3389/fped.2022.982179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/26/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess and summarize current evidence on the effectiveness and safety of ertapenem for treatment of childhood infections, in consideration of high infection prevalence in children and wide use of ertapenem. METHODS The following 8 databases were searched on 13th May 2021: Web of Science, Embase via Ovid SP, PubMed, The Cochrane Library (CENTRAL), Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang. The primary outcome was treatment success rate. Risk ratios (RRs) and 95% confidence interval (CI) were estimated using random-effect models. Subgroup analysis was conducted where heterogeneity was found. RESULTS Fifteen studies (8 randomized controlled trials, 1 observational comparative study, and 6 before and after studies) involving 2,528 patients were included in the final review. Ertapenem had similar treatment success rates with β-lactam antibiotics [relative risk (RR) = 1.08, 95% CI: 0.99-1.19]. In a subgroup analysis, similar efficacy (RR = 1.08, 95% CI: 0.97-1.20) between ertapenem and other carbapenems. Compared with β-lactam antibiotics, ertapenem did not increase the risk of any adverse events (RR = 1.02, 95%CI: 0.71-1.48), drug-related diarrhea (all non-Asian children, RR = 0.62, 95%CI: 0.31-1.25), or injection site pain (all non-Asian children, RR = 1.66, 95%CI: 0.59-4.68). Subgroup analysis showed no obvious difference between ertapenem group and carbapenems or non-carbapenems group on risk of adverse events. CONCLUSION Our findings suggest that ertapenem is effective and safe in treatment for children with infection. Further comparative real-world data is needed to supplement clinical evidence on the overall benefits of ertapenem in this population.
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Affiliation(s)
- Ruiqiu Zhao
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Xiaoru Long
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jiangxia Wang
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jing Zhu
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Cong Liu
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Tingting Shang
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Zhenzhen Zhang
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Engels Obi
- Merck & Co., Inc., Rahway, NJ, United States
| | | | - Yue Kang
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Jie Liu
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Xiaodi Chen
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Hongmei Xu
- Chongqing Key Laboratory of Child Infection and Immunity, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Infectious Diseases of Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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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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30
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Mohammad SA, Rawash LM, AbouZeid AA. Imaging of urinary tract in children in different clinical scenarios: a guide for general radiologists. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Children are frequently referred to the pediatric radiology department due to complaints related to the urinary tract.
Main body
We aimed to describe common clinical scenarios in paediatric urology practice and their recommended imaging diagnostic algorithms. Practical imaging approach to following common clinical scenarios and the common radiological findings are discussed: (A) perinatal urinary tract dilatation and other congenital anomalies; (B) recurrent urinary tract infection; (C) enuresis and daytime urinary incontinence; (D) abdominal masses; (E) flank pain; (F) hematuria; (G) trauma; (H) nonpalpable testis, ambiguous genitalia and common urogenital sinus anomalies; and I) renovascular hypertension
Conclusions
Imaging investigations should be tailored according to the clinical presentation in a stepwise approach aiming for optimum patients’ care.
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Park YS, Lee JH, Kwak YH, Jung JY, Kwon H, Choi YJ, Suh DB, Lee B, Kim MJ, Kim DK. A clinical prediction tool to predict urinary tract infection in pediatric febrile patients younger than 2 years old: a retrospective analysis of a fever registry. Clin Exp Emerg Med 2021; 8:314-324. [PMID: 35000359 PMCID: PMC8743680 DOI: 10.15441/ceem.20.134] [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: 10/12/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Urinary tract infection (UTI) is a significant issue in young febrile patients due to potential long-term complications. Early detection of UTI is crucial in pediatric emergency departments (PEDs). We developed a tool to predict UTIs in children. METHODS Clinical data of patients <24 months of age with a fever and UTI or viral infection were extracted from the fever registry collected in two PEDs. Stepwise multivariate logistic regression was performed to establish predictors of identified eligible clinical variables for the derivation of the prediction model. RESULTS A total of 1,351 patients were included in the analysis, 643 patients from A hospital (derivation set) and 708 patients from B hospital (validation set). In the derivation set, there were more girls and a lower incidence of a past history of UTI, older age, less fever without source, and more family members with upper respiratory symptoms in the viral infection group. The stepwise regression analysis identified sex (uncircumcised male), age (≤12 months), a past history of UTI, and family members with upper respiratory symptoms as significant variables. CONCLUSION Young febrile patients in the PED were more likely to have UTIs if they were uncircumcised boys, were younger than 12 months of age, had a past history of UTIs, or did not have families with respiratory infections. This clinical prediction model may help determine whether to perform urinalysis in the PED.
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Affiliation(s)
- Yun Seong Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Dong Bum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bongjin Lee
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Jung Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Fahimi D, Khedmat L, Afshin A, Jafari M, Bakouei Z, Beigi EH, Kajiyazdi M, Izadi A, Mojtahedi SY. Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis. BMC Infect Dis 2021; 21:1096. [PMID: 34689744 PMCID: PMC8543838 DOI: 10.1186/s12879-021-06798-x] [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: 01/08/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. Methods A retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated. Results 92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI. Conclusions Low BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.
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Affiliation(s)
- Daryoosh Fahimi
- Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Jafari
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakeyeh Bakouei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kajiyazdi
- Department of Pediatric Hematology and Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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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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Isac R, Basaca DG, Olariu IC, Stroescu RF, Ardelean AM, Steflea RM, Gafencu M, Chirita-Emandi A, Bagiu IC, Horhat FG, Vulcanescu DD, Ionescu D, Doros G. Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract. CHILDREN-BASEL 2021; 8:children8070585. [PMID: 34356564 PMCID: PMC8304885 DOI: 10.3390/children8070585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.
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Affiliation(s)
- Raluca Isac
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Diana-Georgiana Basaca
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ioana-Cristina Olariu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ramona F. Stroescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Ist Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Andrada-Mara Ardelean
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ruxandra M. Steflea
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Mihai Gafencu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Adela Chirita-Emandi
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Iulia Cristina Bagiu
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Dan-Dumitru Vulcanescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Dan Ionescu
- Physical Education and Sports Department, Polytechnic University, 300223 Timișoara, Romania;
| | - Gabriela Doros
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
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Montagnani C, Tersigni C, D'Arienzo S, Miftode A, Venturini E, Bortone B, Bianchi L, Chiappini E, Forni S, Gemmi F, Galli L. Resistance Patterns from Urine Cultures in Children Aged 0 to 6 Years: Implications for Empirical Antibiotic Choice. Infect Drug Resist 2021; 14:2341-2348. [PMID: 34188500 PMCID: PMC8236245 DOI: 10.2147/idr.s293279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Urinary tract infection (UTI) is a frequent disorder of childhood, caused mainly by Gram negative Enterobacterales. The aim of this study is to evaluate etiology and antimicrobial susceptibility patterns of bacterial isolates in urine cultures of children under the age of 6 and to analyze the relationship between previous hospitalization or antibiotic prescriptions and antimicrobial resistance rates. Patients and Methods A retrospective study on positive urine cultures from 13 public laboratories in Tuscany, Italy was conducted. Data were obtained by reviewing records of the “Microbiological and Antibiotic-Resistance Surveillance System” (SMART) in Tuscany, Italy. A total of 2944 positive urine cultures were collected from 2445 children. Results Escherichia coli represented the majority of isolates (54,2%), followed by Enterococcus faecalis (12,3%), Proteus mirabilis (10,3%) and Klebsiella pneumoniae (6,6%). Isolated uropathogens showed high resistance rates to amoxicillin-clavulanate (>25%), particularly in children under one year of age or hospitalized within the 12 months before the sample collection. High susceptibility rates were reported of aminoglycosides, cephalosporins and quinolones (>90%). Previous antibiotic prescriptions by general pediatricians did not increase resistance rates. Conclusion Our results show a rate of amoxicillin-clavulanate resistance of 25%. Higher resistance rates were reported in children under one year of age and with previous hospitalization. Hence, amoxicillin-clavulanate should be used carefully in young children and those with severe symptoms.
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Affiliation(s)
- Carlotta Montagnani
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Postgraduate School of Paediatrics, University of Florence, Florence, Italy
| | | | | | | | - Barbara Bortone
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | | | - Luisa Galli
- Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
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Sangeda RZ, Paul F, Mtweve DM. Prevalence of urinary tract infections and antibiogram of uropathogens isolated from children under five attending Bagamoyo District Hospital in Tanzania: A cross-sectional study. F1000Res 2021. [DOI: 10.12688/f1000research.52652.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Urinary tract infection (UTI) is a common condition in children that recurs frequently. This study aimed to determine the prevalence of UTIs among children under five attending Bagamoyo District Hospital and determine its association with nutritional status. Methods: This was a cross-sectional study that enrolled 214 children under five years old attending Bagamoyo District Hospital in Tanzania. Midstream urine was collected in sterile conditions and bottles. Samples were transported to the laboratory to isolate bacteria using cysteine lactose electrolyte deficient (CLED) agar. Identification was undertaken using Gram staining, single iron agar test, sulfide-indole motility (SIM) test, and catalase and oxidase tests. A susceptibility test was done using the disc diffusion method. Anthropometric measurements were employed to assess malnutrition status and body mass index was determined using each child's weight and height. Results: Of the 214 children under five enrolled in the study, 123 (57.4%) were girls and 91 (42.6%) were boys. A total of 35 children were confirmed UTI-positive, making the prevalence 16.4%. Of positive children, 17 (7.9%) were girls and 18 (8.4%) were boys. The UTI prevalence was higher in boys than in girls but not statistically significant (p=0.244). Among the isolated uropathogens, Escherichia coli were common bacteria accounting for 65.7% of all isolates. The rate of other uropathogens isolated was Klebsiella spp. (17.1%), Pseudomonas spp. Proteus spp (11.4%) and (2.9%) and Staphylococci spp. (2.9%). The antibiogram of the isolated bacterial uropathogens showed high in-vitro resistance ranging from 90-95% to erythromycin, trimethoprim-sulfamethoxazole and ampicillin. Conclusion: The prevalence of UTI for children under five was 16.4%. The most common causative agent of UTI was Escherichia coli. There was no association between UTI status and malnutrition status of the children. High resistance to antibiotics calls for antimicrobial stewardship and surveillance to preserve antibiotics' effectiveness in treating uropathogens.
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Savadogo H, Dao L, Tondé I, Tamini/Toguyeni L, Ouédraogo AI, Ouermi AS, Kaboret S, Kaboré A, Kouéta F, Yé D. [Urinary tract infections in a pediatric setting: Bacterial ecology and antibiotic susceptibility at the Pediatric Teaching Hospital Charles-de-Gaulle in Ouagadougou (Burkina Faso)]. Nephrol Ther 2021; 17:532-537. [PMID: 34103257 DOI: 10.1016/j.nephro.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Urinary tract infection is the second most common bacterial infection in children, after respiratory tract infection. The objective of this work was to study the bacterial ecology and antibiotic susceptibility of germs isolated during childhood urinary tract infections at the Paediatric University Hospital Charles-de-Gaulle in Ouagadougou. PATIENTS AND METHOD This was a descriptive retrospective study covering the period from July 1st, 2010 to June 30, 2015, including 141 children from 0 to 15 years old hospitalized in the medical paediatrics department for a urinary tract infection. RESULTS The hospital frequency of urinary tract infection was 0.7%. The mean age of the patients was 43.1 months. Female patients accounted for 57.4%, a sex-ratio of 0.7. Gram-negative bacilli were often involved (67.4%) with Escherichia Coli and Klebsiella in 35.5% and 22% of cases respectively. The main Gram-positive bacteria were staphylococci (15.5%), enterococci (11.3%) and streptococci (5.6%). Enterobacteriaceae isolated were sensitive to netilmicin (80%), chloramphenicol (76.4%), and furan (82.6%). All strains of staphylococcus were susceptible to furan, gentamicin, chloramphenicol and cefixime. In 66.7% of cases, the isolated strains of staphylococcus were resistant to amoxicillin. CONCLUSION Urinary tract infection is a common problem in pediatrics. Its management must be early and adequate based on knowledge of the bacterial ecology in order to reduce the risk of long-term renal complications.
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Affiliation(s)
- Hamidou Savadogo
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso.
| | - Lassina Dao
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Issa Tondé
- Service de laboratoire, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Laure Tamini/Toguyeni
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Arzouma Idrissa Ouédraogo
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Alain Saga Ouermi
- Service de pédiatrie, Centre hospitalier universitaire régional (CHUR) de Ouahigouya, BP 36, Ouahigouya, Burkina Faso
| | - Sonia Kaboret
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Aïssata Kaboré
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
| | - Fla Kouéta
- Département de pédiatrie, Centre hospitalier universitaire Yalgado-Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - Diarra Yé
- Service de pédiatrie médicale et spécialités, Centre hospitalier universitaire pédiatrique Charles-de-Gaulle, 01 BP, 1198 Ouagadougou 01, Burkina Faso
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Durmaz MS, Yorulmaz A, Gokgoz Durmaz F, Arslan S. Utility of 2-Dimensional Shear Wave Elastography for Assessment of the Bladder Wall in Children With Acute Cystitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1105-1111. [PMID: 32888363 DOI: 10.1002/jum.15486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy of 2-dimensional (2D) shear wave elastography (SWE) in the diagnosis of acute cystitis (AC) in children. METHODS Between June 2019 and March 2020, 126 children with AC and 126 healthy participants were prospectively investigated by 2D SWE and B-mode ultrasound. Elastographic measurements were performed by drawing the contours of the posterior wall of the bladder between the ureter orifices using a free region of interest. The quantitative 2D SWE values of the patients and the healthy group were compared. RESULTS The mean 2D SWE values of the bladder wall were significantly higher in patients with AC compared to the healthy group (P = .001). On B-mode ultrasound imaging, the bladder wall thickness of patients with AC was higher than that in the healthy group (P = .001). On 2D SWE, when the cutoff value used was 9.25 kPa, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.1%, 88.1%, 89.3%, and 92.6%, respectively, whereas when the cutoff value used was 1.72 m/s, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.5%, 88.9%, 89.1%, and 90.7%. There was a statistically significant positive correlation between the 2D SWE values and wall thickness measurements (P < .001). CONCLUSIONS Two-dimensional SWE is a noninvasive, fast, and effective imaging method to evaluate the bladder wall in children with AC.
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Affiliation(s)
| | - Alaaddin Yorulmaz
- Department of Radiology, Selcuk University, Medical Faculty, Konya, Turkey
| | | | - Serdar Arslan
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Sofia C, Solazzo A, Cattafi A, Chimenz R, Cicero G, Marino MA, D'angelo T, Manti L, Condorelli E, Ceravolo G, Mazziotti S, Ascenti G. Contrast-enhanced voiding urosonography in the assessment of vesical-ureteral reflux: the time has come. Radiol Med 2021; 126:901-909. [PMID: 33954899 DOI: 10.1007/s11547-021-01360-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
Vesicoureteral reflux (VUR) is a pathological condition contradistinguished by monolateral or bilateral retrograde flow of urine from the bladder to the ureter and to the kidney. If not properly recognized and treated, VUR can potentially be associated to several complications such as recurrent infections and possible secondary scars with Chronic Kidney Disease (CKD). Furthermore, it represents an important risk factor for nephrovascular hypertension. During the last 20 years, the diagnostic approach to this entity has passed through several, drastic changes: indeed, since its introduction in 1994 contrast-enhanced voiding urosonography (ceVUS) has gradually accompanied the voiding cystourethrography (VCUG) as alternative imaging technique for the diagnosis and staging of VUR. Despite a large number of papers has strongly encouraged its use in clinical practice, due to the lack of ionizing radiations and its high sensitivity rate, to date almost all the guidelines only include the VCUG for VUR diagnosis. The introduction of technologically advanced US software and the approval of the intravesical administration of ultrasound contrast agents by the Food and Drug Administration (FDA) and by the European Medicine Agency (EMA) have to induce the Scientific Community to a deep revaluation of the role of ceVUS in the diagnosis and follow-up of VUR: urosonography might extensively replace VCUG as the reference method, reserving to cystourethrography a role in the most complex anatomic settings for pre-surgical evaluation.
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Affiliation(s)
- Carmelo Sofia
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Solazzo
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonino Cattafi
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Roberto Chimenz
- Unit of Pediatric Nephrology With Dialysis, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, "G. Martino" Policlinic, Messina, Italy
| | - Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Maria Adele Marino
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Tommaso D'angelo
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Lauretta Manti
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Elvira Condorelli
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giorgia Ceravolo
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, "G. Martino" Policlinic, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy
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Qindeel M, Barani M, Rahdar A, Arshad R, Cucchiarini M. Nanomaterials for the Diagnosis and Treatment of Urinary Tract Infections. NANOMATERIALS (BASEL, SWITZERLAND) 2021; 11:546. [PMID: 33671511 PMCID: PMC7926703 DOI: 10.3390/nano11020546] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
The diagnosis and treatment of urinary tract infections (UTIs) remain challenging due to the lack of convenient assessment techniques and to the resistance to conventional antimicrobial therapy, showing the need for novel approaches to address such problems. In this regard, nanotechnology has a strong potential for both the diagnosis and therapy of UTIs via controlled delivery of antimicrobials upon stable, effective and sustained drug release. On one side, nanoscience allowed the production of various nanomaterial-based evaluation tools as precise, effective, and rapid procedures for the identification of UTIs. On the other side, nanotechnology brought tremendous breakthroughs for the treatment of UTIs based on the use of metallic nanoparticles (NPs) for instance, owing to the antimicrobial properties of metals, or of surface-tailored nanocarriers, allowing to overcome multidrug-resistance and prevent biofilm formation via targeted drug delivery to desired sites of action and preventing the development of cytotoxic processes in healthy cells. The goal of the current study is therefore to present the newest developments for the diagnosis and treatment of UTIs based on nanotechnology procedures in relation to the currently available techniques.
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Affiliation(s)
- Maimoona Qindeel
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.Q.); (R.A.)
| | - Mahmood Barani
- Department of Chemistry, Shahid Bahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 538-98615, Iran
| | - Rabia Arshad
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.Q.); (R.A.)
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg. 37, D-66421 Homburg, Germany
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Kaselas C, Tse Y, Peace R, Godse A, Lall A, Gopal M. Diagnosing and treating occult vesicoureteric reflux using PIC cystography: Is it influenced by abnormalities on DMSA? J Pediatr Urol 2021; 17:67.e1-67.e7. [PMID: 33246832 DOI: 10.1016/j.jpurol.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/19/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positioning the Instillation of Contrast cystography (PICc) is used to identify occult vesicoureteric reflux (VUR) in patients with recurrent urinary tract infections (UTI) despite optimized bladder and bowel function and without VUR demonstrated on conventional imaging. AIM To determine the incidence of finding occult VUR in such patients usingPICc and the benefit, if any, of treating it. We also assessed if this was influenced by abnormalities on the pre-operative DMSA. PATIENTS AND METHODS This was a retrospective review of PICc in our hospital between 2016 and 2018 and involved three paediatric urologists. The primary indication for PICc was two or more culture proven UTIs despite optimized bladder and bowel function and no reflux on voiding cystourethrography (VCUG) or indirect radionuclide cystography (I-RNC). All children had a preoperative DMSA scan to document any abnormalities. PICc was performed in a standardized way to each ureteric orifice. If occult reflux was found, it was treated concomitantly by cystoscopic injection of Deflux®. To assess the influence of the pre-operative DMSA status, the cohort was subdivided into two groups based on the DMSA scan: Group 1-abnormal DMSA, Group 2-normal DMSA. The median follow-up was 26 months (range 3-39 months). RESULTS PICc was performed in 25 patients [23 females and 2 males; median age: 7 years (range 2-16 years; IQR = 4)]; 17 from Group 1 and 8 from Group 2. Occult VUR was identified in 22 patients (88%); 15/17 (88.2%) in Group 1 and 7/8 (87.5%) in Group 2 (p = 0.9). After cystoscopic treatment, 21/25 (84%) became infection free and this was not influenced by the preoperative DMSA status (p = 0.6). Fig 1. DISCUSSION In this challenging group of patients, looking for and treating occult reflux appears to be clinically useful and beneficial. The ability to test and treat at the same sitting is an added advantage of PICc. The DMSA results did not influence the diagnostic or therapeutic aspect of the process. Our results concur with other published literature. CONCLUSION There is a high incidence of finding occult reflux using PICc in this cohort of patients. Concomitant cystoscopic treatment led to 84% of children becoming infection free on follow up. Abnormalities on DMSA did not influence either the likelihood of finding occult reflux or the likelihood of successful treatment.
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Affiliation(s)
- Christos Kaselas
- Department of Pediatric Urology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Yincent Tse
- Department of Pediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Richard Peace
- Department of Nuclear Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Alok Godse
- Department of Pediatric Urology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Anupam Lall
- Department of Pediatric Urology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Milan Gopal
- Department of Pediatric Urology, Great North Children's Hospital, Newcastle Upon Tyne, UK.
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Roesch J, Harms M, Berger C, Oswald J, Haid B. Targeted Indication of Imaging for Detection of Vesicoureteric Reflux after Pediatric Febrile Urinary Tract Infections Based on a Multiparametric Computational Tool. Indian J Pediatr 2020; 87:1001-1008. [PMID: 32495217 DOI: 10.1007/s12098-020-03329-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/29/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Diagnostic workup after febrile urinary tract infections (fUTIs) in children remains a matter of debate. The authors aimed to evaluate multiple parameters in order to design a predictive tool enabling a targeted indication of voiding cystourethrography (VCUG). METHODS Records of 383 consecutive children who underwent a VCUG as well as a dimercaptosuccinic-acid (DMSA) scan after febrile urinary tract infections (fUTIs) at a single institution between 04/2009 and 06/2014 were reviewed. Twenty parameters were recorded. After regression analysis, 6 parameters were incorporated into a computational tool aiming at a targeted indication of an eventual VCUG. The performance of the tool was prospectively tested on 100 patients. RESULTS Postpyelonephritic alterations on DMSA, duplex systems, age 1-3 y, duration of fever >3 d, >2 fUTIs before VCUG and abnormal sonography findings were identified as significant predictors (p < 0.05 each); the presence of bladder and bowel dysfunction (BBD) was negatively associated with vesicoureteric reflux (VUR). The resulting computational tool achieved an Area under the curve (AUC) of 0.686 (CI 0.633-0.740). Prospective evaluation (100 new patients) revealed a sensitivity of 85.1%, a specificity of 49.1%, a positive predictive value of 59.7% and a negative predictive value of 78.7%. CONCLUSIONS The differentiated indication of a VCUG based on the use of a tool was efficient in optimizing the specificity of the diagnostic algorithm after fUTIs. The tool outperformed other common clinical approaches in terms of VUR detection and VCUG frequency. After validation and further refinement in a multicentric approach, this strategy could significantly enhance VUR detection whilst reducing the number of VCUGs.
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Affiliation(s)
- Judith Roesch
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Mirjam Harms
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Christoph Berger
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Josef Oswald
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria.
- Department of Urology, Ludwig Maximilians University (LMU), Munich, Germany.
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Mamishi S, Shalchi Z, Mahmoudi S, Hosseinpour Sadeghi R, Haghi Ashtiani MT, Pourakbari B. Antimicrobial Resistance and Genotyping of Bacteria Isolated from Urinary Tract Infection in Children in an Iranian Referral Hospital. Infect Drug Resist 2020; 13:3317-3323. [PMID: 33061479 PMCID: PMC7535122 DOI: 10.2147/idr.s260359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 01/31/2023] Open
Abstract
Introduction Urinary tract infection (UTI) is one of the most common bacterial infections in childhood, and the increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents against it has become a major concern. The aim of this study was to determine the antibiotic resistance and genotyping of bacteria isolated from urine cultures in patients referred to the Children’s Medical Center, Tehran, Iran. Methods During the 1-year period, antimicrobial susceptibility profiles of strains isolated from patients with UTI were determined. Typing of the isolates causing nosocomial infections was performed by random amplified polymorphic DNA (RAPD) analysis, and the results were analyzed by Gelcompar II software. Results In this study, 203 children (130 girls and 73 boys) were included. The patients’ age ranged from 1 day to 16 years (IQR average=4 months to 4 years). The most frequent isolated organisms were Escherichia coli (118 isolates, 58%), followed by Klebsiella pneumoniae (30 isolates, 15%). Sixty-two strains (18 strains of E. coli, 13 strains of K. pneumoniae, 11 strains of Enterococcus faecium, and five strains of Burkholderia cepacia complex) had criteria of nosocomial infection. A high resistance rate to trimethoprim-sulfamethoxazole (69%) and cefotaxime (60%) was reported in E. coli and K. pneumoniae strains, respectively. Pseudomonas aeruginosa strains showed high sensitivity to amikacin (100%). All E. faecium strains were susceptible to trimethoprim-sulfamethoxazole (100%), and 23% of the strains were resistant to vancomycin. The analysis of RAPD-typing revealed the presence of three clusters in E. coli, two clusters in E. faecium, and one clone in K. pneumoniae. Besides, four out of five isolates of B. cepacia complex had more than 90% genetic similarity. Conclusion The most frequent isolated pathogen was E. coli, and an increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents such as trimethoprim/sulfamethoxazole and cephalosporins was observed. Moreover, the results of this study showed the presence of clones with ≥80% similarity in E. coli, K. pneumoniae, E. faecium, and B. cepacia complex isolates; therefore, the transmission of nosocomial infections from one patient to another or one ward to another is probable.
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Affiliation(s)
- Setareh Mamishi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Shalchi
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shima Mahmoudi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Babak Pourakbari
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Urinalysis Using a Diaper-Based Testing Device. BIOSENSORS-BASEL 2020; 10:bios10080094. [PMID: 32785051 PMCID: PMC7459906 DOI: 10.3390/bios10080094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 01/24/2023]
Abstract
Urinary tract infections (UTI), one of the most common bacterial infections, annually affect 150 million people worldwide. Infants and the elderly are likely to have missed or delayed diagnosis of UTI due to difficulty clearly describing their symptoms. A rapid screening method for UTI is a critical and urgent need for these populations. The aim of our study is to develop a diaper-based testing device to assay urine biomarkers including pH, leukocyte, and nitrite level. This all-in-one device assists in urine collection and testing using a colorimetric approach to provide easily read visual results on the outside surface of a test strip-integrated diaper. In this study, we tested samples from 46 patients using testing strips and examined the results from 7 patients recruited to validate the strip-integrated diaper. In conclusion, this new diaper-based testing device is easy to use, rapid, and inexpensive, all of which imbue it with tremendous potential for development into a commercially viable UTI screening system.
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45
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Current Management of Urinary Tract Infection and Vesicoureteral Reflux. Indian J Pediatr 2020; 87:625-632. [PMID: 31828601 DOI: 10.1007/s12098-019-03099-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
Urinary tract infection (UTI) is defined as the growth of a significant number of microorganisms of a single species in the urine, in the presence of symptoms. Symptoms in young children are non-specific such as fever without focus; young infants may manifest with irritability, failure to thrive, jaundice, vomiting and diarrhea. Older children usually have symptoms of cystitis or pyelonephritis. Symptoms of cystitis are dysuria, frequency, new onset incontinence and malodorous urine while symptoms of pyelonephritis are high grade fever, flank pain and vomiting. Rapid urine testing by microscopy for pus cells, dipstick testing for leukocyte esterase and nitrite, and enhanced urinalysis are supportive tests. Urine culture samples should be collected with proper technique and results interpreted for significant growth accordingly. Antibiotic therapy for 7-14 d for complicated UTI and 3-4 d for uncomplicated UTI is adequate. Further evaluation is recommended clinically for bladder-bowel dysfunction and obvious anatomical defects and by imaging for vesicoureteral reflux (VUR), usually by micturating cystourethrography (MCU). Since MCU involves exposure to radiation and urethral catheterization, it is now reserved for children with parenchymal involvement or recurrent UTI. VUR is the backward flow of urine into one or both ureters. Clinical manifestations other than UTI include incidental diagnosis on antenatal ultrasonography. Reflux nephropathy, the renal scarring associated with VUR may manifest clinically as hypertension, proteinuria and renal failure. The management of VUR is primarily with antibiotic prophylaxis. Anatomical correction is indicated in case of breakthrough febrile UTI. No intervention has been shown to reduce renal scarring.
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Sadeghi-Bojd S, Naghshizadian R, Mazaheri M, Ghane Sharbaf F, Assadi F. Efficacy of Probiotic Prophylaxis After The First Febrile Urinary Tract Infection in Children With Normal Urinary Tracts. J Pediatric Infect Dis Soc 2020; 9:305-310. [PMID: 31100124 DOI: 10.1093/jpids/piz025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Growing antibiotic resistance and debates over their efficacy for urinary tract infection (UTI) recurrence warrants studying nonantibiotic prophylaxis for preventing UTI recurrences. METHODS We randomly assigned 181 children, aged 4 months to 5 years, with a normal urinary tract after recovery from their first febrile UTI in a 1:1 ratio to receive a probiotic mixture of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, and Bifidobacterium lactis (n = 91) or placebo (n = 90) for a total of 18 months of therapy. The primary objective was to show the superiority of probiotic prophylaxis to placebo. The primary end point was composite cure (UTI-free survival) at 18 months, and the secondary end point was the median time to first UTI recurrence. RESULTS The probiotics were superior to placebo with respect to the primary efficacy end point. At 18 months, composite cure was observed in 96.7% (3 of 91) of the patients in the probiotic group and 83.3% (15 of 90) of those in the placebo group (P = .02). The median time to the first incidence of UTI recurrence was 3.5 months (range, 1-4 months) and 6.5 months (range, 2-14 months) in the probiotic and placebo groups, respectively (P = .04). The main microorganism that caused recurrent UTI was Escherichia coli, followed by Klebsiella pneumoniae, and these results were not significantly different between the 2 groups. We found no specific adverse events among the participants who received the probiotic mixture during the course of therapy. CONCLUSIONS The probiotics were more effective than placebo at reducing the risk of recurrent UTI in children with a normal urinary tract after their first episode of febrile UTI.
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Affiliation(s)
- S Sadeghi-Bojd
- Department of Pediatrics, Division of Nephrology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - R Naghshizadian
- Department of Pediatrics, Section of Nephrology, Kurdistan University of Medical Science, Sanandaj, Iran
| | - M Mazaheri
- Department of Pediatrics, Section of Nephrology, Semnan University of Medical Science1 Semnan, Iran
| | - F Ghane Sharbaf
- Department of Pediatrics, Division of Nephrology, Dr Sheikh Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - F Assadi
- Department of Pediatrics, Division of Nephrology, Rush University Medical Center, Chicago, Illinois
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Cundy TP, Barker A, Borzi P, Khurana S. Variation in ureteric re-implantation for Australian children. ANZ J Surg 2020; 91:1011-1016. [PMID: 32419287 DOI: 10.1111/ans.15995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Management options for vesicoureteric reflux are numerous, increasingly diversifying and debated. There is longstanding anecdotal opinion of inexplicable regional variation in vesicoureteric reflux management in Australia. This study investigates temporal trends in ureteric re-implantation for children, and variation between states and territories. METHODS Ureteric re-implantation data for children aged 0-14 years were retrieved from the Medicare Benefits Scheme item reports database for the 20-year period from 1998-2017. Claims data were population adjusted for each state then standardized for age using Australian Bureau of Statistics records. National and regional trends were calculated using joinpoint regression. Comparison between eastern (New South Wales, Victoria, Queensland, Tasmania, Australian Capital Territory) and western or central (Western Australia, South Australia) states was performed using the Mann-Whitney U-test. RESULTS There were 4919 procedure rebate claims during the study period. A national decrease in claim rates of 6.3% per 100 000 children was identified (P < 0.001). This was derived from significant decreases observed in eastern states. There was a threefold higher claim rate in Western Australia and South Australia per annum compared to the remainder of the country (4.0 versus 12.6 per 100 000; P < 0.001). For the most recent 5 years of the study period, this difference increased to a sevenfold higher rate (1.6 versus 11.1; P < 0.001). CONCLUSION There has been a dramatic nationwide decline in the rate of ureteric re-implantation procedure claims. Regional disparity between each side of the country is widening. Further research is required to determine if this degree of variation is warranted or unwarranted. The observed regional variation facilitates opportunity for a nationwide pragmatic clinical trial.
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Affiliation(s)
- Thomas P Cundy
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Barker
- Department of Paediatric Surgery, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter Borzi
- Department of Paediatric Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Sanjeev Khurana
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Clinical Characteristics of Pediatric Pyelonephritis Without Pyuria or Bacteriuria. Pediatr Infect Dis J 2020; 39:385-388. [PMID: 32187138 DOI: 10.1097/inf.0000000000002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have neither of these findings [APN(P(-);B(-))]. METHODS In this study, we investigated APN patients who visited our hospital over 14 years to identify specific clinical characteristics of APN(P(-);B(-)). RESULTS A total of 171 APN patients were included in the study, and of these 29 were APN(P(-);B(-)). Of the APN(P(-);B(-)) patients, 25.9% had vesicoureteral reflux (VUR), the same percentage as the APN(P(+);B(+)) patients, and 69.0% of APN(P(-);B(-)) patients had already taken antibiotics before diagnosis. APN(P(-);B(-)) patients were older and had a longer duration between onset of fever and diagnosis than the patients with pyuria and/or bacteriuria. In addition, they showed higher C-reactive protein levels. APN(P(-);B(-)) patients had high levels of urinary α-1 microglobulin and urinary β-2 microglobulin. CONCLUSIONS APN is difficult to diagnose in febrile patients who display neither pyuria nor bacteriuria, but as these patients have the same risk for VUR as APN patients with pyuria and bacteriuria, a detailed history establishing the clinical course as well as urinary chemistry investigations, may assist in diagnosis.
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Simões E Silva AC, Oliveira EA, Mak RH. Urinary tract infection in pediatrics: an overview. J Pediatr (Rio J) 2020; 96 Suppl 1:65-79. [PMID: 31783012 PMCID: PMC9432043 DOI: 10.1016/j.jped.2019.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/12/2019] [Accepted: 10/16/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients. SOURCE OF DATA Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases. SUMMARY OF FINDINGS Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection. CONCLUSION Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.
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Affiliation(s)
- Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
| | - Eduardo A Oliveira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Robert H Mak
- University of California, Rady Children's Hospital San Diego, Division of Pediatric Nephrology, San Diego, United States
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