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Abda A, Panetta L, Blackburn J, Chevalier I, Lachance C, Ovetchkine P, Sicard M. Urinary tract infections in very premature neonates: the definition dilemma. J Perinatol 2024; 44:731-738. [PMID: 38553603 DOI: 10.1038/s41372-024-01951-1] [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] [Received: 05/29/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Data on urinary tract infections (UTIs) in very preterm neonates (VPTNs) are scarce. We aimed to (i) describe the characteristics of UTIs in VPTNs and (ii) compare the diagnostic practices of neonatal clinicians to established pediatric guidelines. METHODS All VPTNs (<29 weeks GA) with a suspected UTI at the CHU Sainte-Justine neonatal intensive care unit from January 1, 2014, and December 31, 2019, were included and divided into two definition categories: Possible UTI, and Definite UTI. RESULTS Most episodes were Possible UTI (87%). Symptoms of UTIs and pathogens varied based on the definition category. A positive urinalysis was obtained in 25%. Possible UTI episodes grew 2 organisms in 62% of cases and <50,000 CFU/mL in 62% of cases. CONCLUSION Characteristics of UTIs in VPTNs vary based on the definition category and case definitions used by clinicians differ from that of established pediatric guidelines.
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Affiliation(s)
- Assil Abda
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
| | - Luc Panetta
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Pediatric Emergency Department, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - Julie Blackburn
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada
| | - Isabelle Chevalier
- Department of Pediatrics, Division of General Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Christian Lachance
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Philippe Ovetchkine
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Melanie Sicard
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
- Research center, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada
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Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A, Khandelwal P, Ekambaram S, Pais P, Sharma J, Kanitkar M, Bagga A. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatr Nephrol 2024; 39:1639-1668. [PMID: 37897526 DOI: 10.1007/s00467-023-06173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 10/30/2023]
Abstract
We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
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Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Kumar
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Arpana Iyengar
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sudha Ekambaram
- Department of Pediatric Nephrology, Apollo Children's Hospital, Chennai, India
| | - Priya Pais
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Jyoti Sharma
- Department of Pediatrics, KEM Hospital, Pune, India
| | | | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Predavec N, Perčinić A, Herljević Z, Rezo Vranješ V, Pavlović M, Šalek Z, Kuliš T, Bilić E, Mareković I. Bacteriuria in Paediatric Oncology Patients: Clinical Features, Distribution and Antimicrobial Susceptibility of Bacterial Pathogens at University Hospital Centre Zagreb, Croatia over a 4-Year Period. Antibiotics (Basel) 2024; 13:118. [PMID: 38391504 PMCID: PMC10886334 DOI: 10.3390/antibiotics13020118] [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: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Bacteriuria in paediatric oncology patients have not been well studied. This retrospective study analysed clinical features, distribution and antimicrobial susceptibility of bacterial pathogens cultured from urine in paediatric oncology patients over a 4-year period (2019-2022). A total of 143 episodes of bacteriuria were documented in 74 patients. Neutropenia was present in 17.5% (25/143), symptoms in 25.9% (37/143) and urinary catheter in 7.0% (10/143) episodes. Symptomatic bacteriuria episodes were statistically significantly more frequent in patients with neutropenia (p = 0.0232). The most common bacterial pathogens were Escherichia coli (n = 49; 32.2%), Klebsiella spp. (n = 34; 22.4%), Pseudomonas aeruginosa (n = 22; 14.5%) and Enterococcus spp. (n = 21; 13.8%). Extended-spectrum β-lactamases-producing (ESBL) Enterobacterales were found in 11 episodes (11/143; 7.7%) with the highest proportion among Klebsiella pneumoniae isolates (n = 7/34; 20.6%). No carbapenem-resistant Enterobacterales, multidrug-resistant P. aeruginosa or vancomycin-resistant Enterococcus spp. were found. The most important novelties are demonstrating P. aeruginosa as one of the prominent bacteriuria pathogens in this patient population, presence of ESBL isolates and carbapenem-resistant P. aeruginosa later during hospitalization highlights the need for appropriate antimicrobial treatment. However, because of the small number of symptomatic patients, further studies are needed to clarify the importance of including urine culture in the diagnostic process in patients with febrile neutropenia.
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Affiliation(s)
- Nina Predavec
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Antonio Perčinić
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Herljević
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Violeta Rezo Vranješ
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Pavlović
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zrinko Šalek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Ernest Bilić
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Mareković
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Chen I, Hsu LS, Yao CS, Chang JT, Wang HP, Fang NW. Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study. Front Pediatr 2024; 12:1332052. [PMID: 38333085 PMCID: PMC10850320 DOI: 10.3389/fped.2024.1332052] [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: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Background Urinary tract infection (UTI) is a potential cause of neonatal jaundice. Nevertheless, there remains a lack of consensus regarding appropriate screening practices for UTI in infants with hyperbilirubinemia. This study aimed to analyze a group of jaundiced infants to assess the prevalence of UTI, explore potential risk factors, and examine the impact of UTI on the course and severity of neonatal jaundice. Methods This retrospective case-control study was conducted on 150 jaundiced infants (aged < 8 weeks) without a known etiology in the hyperbilirubinemia work-up. All subjects underwent phototherapy treatment and UTI screening by catheterization. They were then classified into UTI and non-UTI groups based on urine culture results, with a positive urine culture indicating the growth of ≥10,000 colony-forming units. The clinical characteristics and jaundice-related parameters of both groups were analyzed. Results Among the 150 jaundiced patients, the prevalence of UTI was 29%. There was a significantly higher male predominance in the UTI group, and patients with UTI also had a significantly longer duration of hospitalization compared to those without UTI. Significant risk factors associated with UTI in jaundiced infants included male gender and a peak total bilirubin level higher than 18 mg/dl during hospitalization. The most common pathogens identified in urine culture were Escherichia coli (41.9%) and Enterococcus faecalis (30.2%). Conclusion In cases of neonatal jaundice where the underlying cause is not evident, screening for UTI should be performed, particularly when associated risk factors or inadequate response to phototherapy is present.
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Affiliation(s)
- Ing Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li-Sang Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cai-Sin Yao
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jenn-Tzong Chang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Ping Wang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Wen Fang
- Department of Pediatrics, Pingtung Veterans General Hospital, Pingtung, Taiwan
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Liang D, Wang ME, Dahlen A, Liao Y, Saunders AC, Coon ER, Schroeder AR. Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2350061. [PMID: 38170521 PMCID: PMC10765266 DOI: 10.1001/jamanetworkopen.2023.50061] [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] [Received: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
IMPORTANCE Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes. OBJECTIVES To examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity. DESIGN, SETTING, AND PARTICIPANTS This retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021. EXPOSURE Time periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021). MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis. RESULTS The cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: -33.1% (95% CI, -39.4% to -26.1%) for all children and -52.1% (95% CI, -62.1% to -39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (-4.3%; 95% CI, -32.0% to 34.6% for all children) after the first 3 months of the pandemic. CONCLUSIONS AND RELEVANCE In this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.
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Affiliation(s)
- Danni Liang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Marie E. Wang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Alex Dahlen
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Yungting Liao
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Andrew C. Saunders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Eric R. Coon
- Department of Pediatrics, Primary Children’s Hospital and University of Utah School of Medicine, Salt Lake City
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Girma A, Aemiro A, Workineh D, Tamir D. Magnitude, Associated Risk Factors, and Trend Comparisons of Urinary Tract Infection among Pregnant Women and Diabetic Patients: A Systematic Review and Meta-Analysis. J Pregnancy 2023; 2023:8365867. [PMID: 37545868 PMCID: PMC10403334 DOI: 10.1155/2023/8365867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/12/2023] [Accepted: 05/19/2023] [Indexed: 08/08/2023] Open
Abstract
Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people with diabetes mellitus (DM). This systematic review and meta-analysis was aimed at finding the pooled prevalence of UTI and its associated risk factors among PW and DM patients. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, Google Engine, and University Library Databases. "Prevalence," "urinary tract infection," "associated factors," "pregnant women," "diabetic patients," and "Ethiopia" were search terms used for this study. For critical appraisal, PRISMA-2009 was applied. Heterogeneity and publication bias were evaluated using Cochran's Q, inverse variance (I2), and funnel plot asymmetry tests. A random effect model was used to calculate the pooled prevalence of UTI and its associated factors among both patients, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 7271 participants were included in the 25 eligible studies. The pooled prevalence of UTI in Ethiopia among both patients was 14.50% (95% CI: 13.02, 15.97), of which 14.21% (95% CI: 12.18, 16.25) and 14.75% (95% CI: 12.58, 16.92) were cases of DM and PW, respectively. According to the subgroup analysis, the highest prevalence was observed in the Oromia region (19.84%) and in studies conducted from 2018 to 2022 (14.68%). Being female (AOR: 0.88, and 95% CI: 0.11, 1.65, P = 0.01) and having an income level ≤ 500ETB (AOR: 4.46, and 95% CI: -1.19, 10.12, P = 0.03) were risk factors significantly associated with UTI among patients with DM and PW, respectively. Furthermore, a history of catheterization (AOR = 5.58 and 95% CI: 1.35, 9.81, P < 0.01), urinary tract infection (AOR: 3.52, and 95% CI: 1.96, 5.08, P < 0.01), and symptomatic patients (AOR: 2.32, and 95% CI: 0.57, 4.06, P < 0.01) were significantly associated with UTI in both patients. Early diagnosis and appropriate medication are necessary for the treatment of UTI in patients with DM and PW.
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Affiliation(s)
- Abayeneh Girma
- Department of Biology, College of Natural and Computational Science, Mekdela Amba University, P.O. Box 32, Tulu Awlia, Ethiopia
| | - Aleka Aemiro
- Department of Biology, College of Natural and Computational Science, Mekdela Amba University, P.O. Box 32, Tulu Awlia, Ethiopia
| | - Dereba Workineh
- Department of Biology, College of Natural and Computational Science, Mizan-Tepi University, P.O. Box 121, Tepi, Ethiopia
| | - Dessalew Tamir
- Department of Veterinary Science, College of Agriculture and Environmental Sciences, Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia
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Zhang K, Zhang Y, Chao M, Hao Z. Prevalence, Pathogenic Bacterial Profile and Antimicrobial Susceptibility Pattern of Urinary Tract Infection Among Children with Congenital Anomalies of the Kidney and Urinary Tract. Infect Drug Resist 2023; 16:4101-4112. [PMID: 37396068 PMCID: PMC10312322 DOI: 10.2147/idr.s399442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/15/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose The study was to detect the pathogenic bacterial profile and antibiogram among children with congenital anomalies of the kidney and urinary tract (CAKUT). Patients and Methods A retrospective analysis was performed using medical records of urine culture results and antibiotic susceptibility results in patients with UTIs from March 2017 to March 2022. Antimicrobial susceptibility pattern was determined by a standard agar disc diffusion method. Results A total of 568 children were included. The proportion of culture-positive UTI was 59.15% (336/568). More than nine types of bacteria were isolated with most pathogens being Gram-negative species. Among Gram-negative isolates, the predominant bacteria were Escherichia coli (30.95%, 104/336) followed by Klebsiella pneumoniae (9.23%). Escherichia coli isolates were highly sensitive to amikacin (95.19%), ertapenem (94.23%), nitrofurantoin (93.27%), imipenem (91.35%), and piperacillin-tazobactam (90.38%) and high rate of resistant were also detected to ampicillin (92.31%), cephazolin (73.08%), ceftriaxone (70.19%), trimethoprim-sulfamethoxazole (61.54%) and ampicillin-sulbactam (57.69%). Klebsiella pneumoniae isolates showed sensitive to ertapenem (96.77%), amikacin (96.77%), imipenem (93.55%), piperacillin-tazobactam (90.32%) and gentamicin (83.87%), while highly resistant were observed to ampicillin (96.77%), cephazolin (74.19%), ceftazidime (61.29%), ceftriaxone (61.29%), and aztreonam (61.29%). The isolated Gram-positive bacteria mainly contained Enterococcus faecalis and Enterococcus faecium (each 15.77%). Enterococcus faecalis were sensitive to vancomycin, penicillin-G, tigecycline, nitrofurantoin and linezolid (100%, 94.34%, 88.68%, 88.68%, 86.79, respectively) and resistant to tetracycline (86.79%), quinupristi (83.02%), erythromycin (73.58%). Enterococcus faecium also showed a similar result. Multiple drug resistance (MDR) was observed in 264 (80.00%) of the 360 bacterial isolates. Only age was significantly associated with a culture-positive UTI. Conclusion A higher prevalence of culture-positive UTI was detected. Escherichia coli was the most prevalent uropathogen followed by Enterococcus faecalis and Enterococcus faecium. These uropathogens showed highly resistant to the commonly used antibiotics. Moreover, MDR was commonly observed. Thus, empiric therapy is unsatisfactory as drug sensitivity always varies over time.
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Affiliation(s)
- Kaiping Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology, Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, 230000, People’s Republic of China
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, Anhui Province, 230000, People’s Republic of China
| | - Yin Zhang
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, Anhui Province, 230000, People’s Republic of China
| | - Min Chao
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, Anhui Province, 230000, People’s Republic of China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology, Anhui Medical University; Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui Province, 230000, People’s Republic of China
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8
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Steele G, Tan W, Saleeby CE, Zanger K. Staphylococcus Epidermidis as a Uropathogen in Children. Urology 2023; 176:183-186. [PMID: 36858321 DOI: 10.1016/j.urology.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
Historically, Staphylococcus epidermidis has been considered a contaminant when grown on urine cultures. However, a growing body of literature suggests that S. epidermidis can cause urinary tract infections (UTIs) in children with anatomic variants or a history of instrumentation. In this case report, we describe a previously healthy child who presented with symptoms of UTI and urine cultures grew this uropathogen. The patient was screened for anatomic abnormalities and none were found; nonetheless, appropriate treatment should be initiated even if no underlying pathology is found.
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Affiliation(s)
| | - Weizhen Tan
- Harvard Medical School, Boston, MA; Division of Nephrology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Chadi El Saleeby
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Kerstin Zanger
- Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
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Redondo Sánchez J, Domínguez Lázaro AM, Rodríguez Barrientos R, Barrio Cortes J, Seoane Sanz A, Bravo Acuna J, Del Cura-González I. Trends in hospitalization for urinary tract infection in the paediatric age group in the 2000-2015 period in Spain. An Pediatr (Barc) 2023; 98:175-184. [PMID: 36804332 DOI: 10.1016/j.anpede.2023.01.009] [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: 05/31/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To analyse the trends in hospital admissions related to urinary tract infection among children aged 0-14 years in Spain in the 2000-2015 period. METHODS We conducted a retrospective observational study using the minimum basic hospital discharge dataset system of Spain, which applies the International Classification of Diseases, version 9 (ICD-9) coding system. We included every hospitalisation due to cystitis, pyelonephritis and unspecified UTI among children aged less than 15 years. We collected data on patient sex and age, type of discharge, main diagnosis, comorbidities, length of stay and overall cost. We calculated crude hospitalization rates per 1000 inhabitants aged less than 15 years and performed a joinpoint regression analysis to identify temporal trends. RESULTS In the 2000-2015 period, there were 124 696 hospitalizations in children under 15 years. Of these patients, 72.97% were aged 0-1 year and 60.12% had a diagnosis of unspecified UTI, 39.27% of pyelonephritis, and 0.52% of cystitis. The crude rate of hospitalization due to UTI ranged from 1.24 in year 2000 to 0.98 in 2015. The rate of hospitalization was higher in female versus male patients. The joinpoint analysis found a decreasing trend in the rate of hospitalization due to UTI, with an average annual percent change (AAPC) of -1.5% (95% confidence interval [CI], -2.4 a -0.6). The largest decreases occurred in female patients (AAPC, -1.8; 95% CI, -2.5 a -1.0) and children aged 7-10 years (AAPC - 5.9; 95% CI, -6.7 a -5.2). CONCLUSIONS The rate of hospitalization related to UTI in Spain in patients aged up to 14 years decreased during the 2000-2015 period. The highest hospitalization rates occurred in female patients and in the 0-to-1 year age group.
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Affiliation(s)
- Jesús Redondo Sánchez
- Centro de Salud Ramon y Cajal, Alcorcón, Spain; Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Alberto Manuel Domínguez Lázaro
- Medicina Preventiva y Salud Pública, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ricardo Rodríguez Barrientos
- Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaime Barrio Cortes
- Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, Madrid, Spain
| | - Andrea Seoane Sanz
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Bravo Acuna
- Centro de Salud El Greco, Getafe. Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Isabel Del Cura-González
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
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Daniel M, Szymanik-Grzelak H, Sierdziński J, Podsiadły E, Kowalewska-Młot M, Pańczyk-Tomaszewska M. Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. J Pers Med 2023; 13:jpm13010138. [PMID: 36675799 PMCID: PMC9865477 DOI: 10.3390/jpm13010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The study aimed to determine the clinical symptoms, laboratory tests, risk factors, and etiology of different UTIs in children admitted to pediatric hospitals for three years. Methods: Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. Results: We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5−48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in children with APN than with CYS. The risk factors of UTIs were presented in 46.6% of patients, of which 35.6% were children with APN and 61.7% with CYS. The main risk factor was CAKUT, more frequently diagnosed in children with CYS than APN, mainly in children <2 years. The most commonly isolated bacteria were Escherichia coli (74%). There was a higher percentage of urine samples with E. coli in girls than in boys. Other bacteria found were Klebsiella species, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus species. Conclusions: Patients with APN were younger and had higher inflammatory markers. Often, fever is the only symptom of UTI in children, and other clinical signs are usually non-specific. The most common UTI etiology is E. coli, regardless of the clinical presentation and risk factors.
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Affiliation(s)
- Maria Daniel
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence: ; Tel.: +48-317-97-35
| | - Hanna Szymanik-Grzelak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Edyta Podsiadły
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research, Faculty of Pharmacy, Medical University of Warsaw, 02-091 Warsaw, Poland
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Elale AK, Manilal A, Tadesse D, Seid M, Dubale A. Magnitude and associated factors of bacterial urinary tract infections among paediatric patients in Arba Minch, southern Ethiopia. New Microbes New Infect 2023; 51:101083. [PMID: 36691648 PMCID: PMC9860381 DOI: 10.1016/j.nmni.2023.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Bacterial urinary tract infections (UTI) commonly occur in children; if left untreated, they may result in severe consequences such as uro-sepsis and renal damage. This study aimed to determine the bacterial profile, antimicrobial susceptibility patterns and associated factors among paediatric patients suspected of urinary tract infections in Arba Minch General Hospital (AMGH). An institution-based cross-sectional study was conducted from 01 October 2020 to 31 January 2021. A convenient sampling technique was used to recruit the participants; data were collected using a pre-tested questionnaire. To quantify the bacteria (as per the Kass count, >105CFU/ml), midstream urine samples were streaked onto bacteriological media. Isolates were identified by following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analyzed using SPSS software. Out of the 246 children included, 38 (15.4%) were found to be positive for significant bacteriuria. Isolates of Escherichia coli, 9/38 (23.7%), and Staphylococcus aureus, 9/38 (23.7%), were the most predominant. The majority of Gram-negative bacterial (GNB) isolates showed resistance towards amoxicillin-clavulanate (89.5%), ampicillin (84.6%), and ceftazidime (81%). Likewise, 76.9 and 76.5% of Gram-positive bacteria (GPB), respectively, had shown resistance towards co-trimoxazole and tetracycline. Multi-drug and extensively drug resistance were detected respectively in the case of 68.4 and 15.8% of the total isolates; ESBL production was found in 57.1% of GNB, whereas 55.6% of S. aureus were methicillin-resistant S. aureus (MRSA). The process of un-circumcision was significantly associated with UTI [(adjusted odds ratio= 3.578; 95% confidence interval: 1.263 - 10.13; p=0.016)].
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Affiliation(s)
| | - Aseer Manilal
- Corresponding author. Dept. of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
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Tendencias en la hospitalización por infección del tracto urinario en la población pediátrica de España en el período 2000-2015. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Effect of the COVID-19 outbreak on emergency transport of children by an emergency medical service system: a population-based, ORION registry study. BMC Emerg Med 2022; 22:206. [PMID: 36539698 PMCID: PMC9767795 DOI: 10.1186/s12873-022-00765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has spread rapidly around the world. OBJECTIVE To assess the effect of the COVID-19 pandemic on the emergency medical service (EMS) and hospital admission course for children transported by ambulance. METHODS This study was a retrospective, descriptive study with a study period from January 1, 2018 to December 31, 2020 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. All children who were transported by ambulance in Osaka Prefecture were included. The main outcome of this study was the rate of difficult-to-transfer cases, which was calculated by univariate and multivariate Poisson regression analyses. RESULTS Over the 3 years between January 1, 2018 and December 31 2020, 1,436,212 patients were transported to hospitals by ambulances in Osaka Prefecture, with children accounting for 102,473 (37,064, 39,590, and 25,819, in 2018, 2019, and 2020, respectively). Poisson regression analysis showed that children were negatively associated with difficult-to-transfer cases (risk ratio (RR) 0.35, 95% CI 0.33 to 0.37). With reference to 2018, 2020 was not significantly associated with difficult-to-transfer cases in children (RR 1.14, 95% CI 0.99 to 1.32, P = 0.075), but was significantly related (RR 1.24, 95% CI 1.21 to 1.27, P < 0.001) to difficult-to-transfer cases in the general population. CONCLUSION Children were consistently associated with a reduced RR for difficult-to-transfer cases, even in the COVID-19 pandemic in 2020.
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DEGER I, ERTUĞRUL S, YOLBAŞ I, TEKIN R. Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia. Minerva Pediatr (Torino) 2022; 74:562-567. [DOI: 10.23736/s2724-5276.21.06295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wolska L, Kowalewski M, Potrykus M, Redko V, Rybak B. Difficulties in the Modeling of E. coli Spreading from Various Sources in a Coastal Marine Area. Molecules 2022; 27:molecules27144353. [PMID: 35889226 PMCID: PMC9316465 DOI: 10.3390/molecules27144353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022] Open
Abstract
Coastal and transitional waters are often used as bathing waters. In many regions, such activities play an important economic role. According to the European Union Bathing Water Directive (2006/7/EC) (BWD) the concentration of Escherichia coli in bathing water exceeding 500 CFU·100 mL−1 poses a high risk for bathers’ health. In order to safeguard public health, microbiological environmental monitoring is carried out, which has recently been supported or replaced by mathematical models detailing the spread of sanitary contamination. This study focuses on the problems and limitations that can be encountered in the process of constructing a mathematical model describing the spread of biological contamination by E. coli bacteria in coastal seawater. This and other studies point to the following problems occurring during the process of building and validating a model: the lack of data on loads of sanitary contamination (often connected with multiple sources of biological contamination inflow) makes the model more complex; E. coli concentrations higher than 250 CFU·100 mL−1 (low hazard for health) are observed very rarely, and are associated with great uncertainty; the impossibility of predicting the time and intensity of precipitation as well as stronger winds and rougher sea, which may be a significant source of E. coli. However, there is universal agreement that such models will be useful in managing bathing water quality and protecting public health, especially during big failures of the wastewater network.
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Affiliation(s)
- Lidia Wolska
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, 80-204 Gdańsk, Poland; (L.W.); (M.P.); (V.R.)
| | - Marek Kowalewski
- Institute of Oceanography, University of Gdańsk, Av. Marszałka Piłsudskiego 46, 81-378 Gdynia, Poland;
| | - Marta Potrykus
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, 80-204 Gdańsk, Poland; (L.W.); (M.P.); (V.R.)
| | - Vladyslav Redko
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, 80-204 Gdańsk, Poland; (L.W.); (M.P.); (V.R.)
| | - Bartosz Rybak
- Department of Environmental Toxicology, Faculty of Health Sciences, Medical University of Gdańsk, Dębowa Str. 23A, 80-204 Gdańsk, Poland; (L.W.); (M.P.); (V.R.)
- Correspondence: ; Tel.: +48-58-349-1935
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Isolation, Identification, Characterization, and Plasmid Profile of Urinary Tract Infectious Escherichia coli from Clinical Samples. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7234586. [PMID: 35356239 PMCID: PMC8958076 DOI: 10.1155/2022/7234586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 12/04/2022]
Abstract
Objective In recent times, urinary tract infection (UTI) is one of the most widely recognized bacterial diseases all over the planet. UTI influences individuals of any age and gender. The target of this study is to concentrate on the recurrence of uropathogens, the antimicrobial susceptibility pattern of the isolates, and the plasmid profile of people from the government clinics of Karaikudi. Methods From July 2017 to December 2017, 100 urine tests were gathered and handled for the isolation of pathogenic microbes. In total, 89 isolates were found from the samples collected. Results Escherichia coli was discovered as the most common bacterial isolate screened from the UTI-infected people, accounting for 28.09 percent of all isolates. E. coli was seen to be the highest prevalent bacterium for UTI in all age groups and demonstrated resistance to routinely used medications, especially cefpodoxime and novobiocin, which have been 100 percent resistant. The E. coli isolates screened were positive for beta-lactamase and film generation, and they have strong antimicrobial resistance. As a result, the E. coli strains with the highest prevalence of virulence determinants have become more resistant to many medications because they support the microorganism in overcoming the host's defense and colonizing or entering the urinary system. The amplified 16S rRNA product was analyzed, and phylogenetic relationships were determined. The presence of TEM (56 percent), CTX-M (64 percent), SHV (40 percent), and OXA (60 percent) was discovered. Among E. coli isolates, CTX-M was the most common extended spectrum-beta lactamase (ESBL). Multiplex PCR was also used to identify the existence of CTX-M subgroups in E. coli isolates. Conclusion Finally, we urge that antibiotic selection should be predicated on the awareness of the specific prevalence and that novel antimicrobial medicines for urinary infections be developed to combat the overuse of antibiotics.
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Almatrafi MA, Sindi L, Alshehri M, Sendi E, Sindi G, Alzahrani G, Alwan J, Salawati E, Alwafi H, Minshawi F, Mosalli R, Samannodi M. Parental Knowledge and Awareness of Childhood Urinary Tract Infections: A Cross Sectional Survey. Patient Prefer Adherence 2022; 16:2423-2430. [PMID: 36072916 PMCID: PMC9444035 DOI: 10.2147/ppa.s361313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Parent's misconceptions or lack of knowledge about childhood urinary tract infections (UTIs) can negatively impact their children's health. Therefore, the present study aimed to determine the childhood urinary tract infections awareness and understanding among parents in Saudi Arabia. PATIENTS AND METHODS An online validated cross-sectional survey of parents in Saudi Arabia was conducted from August to September 2021. Study participants who met the inclusion criteria were selected using a convenience sampling technique. A questionnaire with two domains was used to assess parental awareness of childhood urinary tract infection symptoms, complications, treatment, prevention, epidemiology, and diagnosis. The total childhood urinary tract infections awareness scores were classified into three categories: low awareness, moderate awareness, and high awareness. Descriptive statistics were used to determine the data distribution. A chi-square test was used to evaluate the relationship between parental awareness about urinary tract infections in children and other variables. Statistical significance was established at 0.05. RESULTS Of the 1688 parents who completed the survey, 1289 (76.4%) were female, 1581 (93.7%) were married, and 1161 (68.8) had a university degree. Parent's total awareness scores were high; however, individual domain scores indicate a moderate level of knowledge. Statistically significant relationship were observed between total awareness and gender, occupation, and level of educational level ((P=0.004, P=0.001, P=0.007, respectively). Another statistically significant relationship was noted between the history of urinary tract infections and awareness of disease prevention (P=0.009). CONCLUSION In Saudi Arabia, parental knowledge about childhood urinary tract infections is moderate to high. However, future studies are needed to investigate gender, educational, and occupational variations in childhood UTI knowledge among parents in Saudi Arabia.
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Affiliation(s)
| | - Lama Sindi
- Medical College of Umm Al-Qura University, Makkah, Saudi Arabia
| | - Malak Alshehri
- Medical College of Umm Al-Qura University, Makkah, Saudi Arabia
| | - Esraa Sendi
- Medical College of Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghufran Sindi
- Medical College of Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Joud Alwan
- Medical College of Umm Al-Qura University, Makkah, Saudi Arabia
| | - Emad Salawati
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hassan Alwafi
- Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Faisal Minshawi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed Samannodi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Correspondence: Mohammed Samannodi, Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia, Tel +966548293937, Fax +966125502188, Email
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YÜKSEL S, BECERİR T, SEYHAN B. The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections. PAMUKKALE MEDICAL JOURNAL 2021:908-915. [DOI: 10.31362/patd.990677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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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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Parente G, Gargano T, Pavia S, Cordola C, Vastano M, Baccelli F, Gallotta G, Bruni L, Corvaglia A, Lima M. Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study. CHILDREN-BASEL 2021; 8:children8060436. [PMID: 34071019 PMCID: PMC8224700 DOI: 10.3390/children8060436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022]
Abstract
Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
- Correspondence:
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Stefania Pavia
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Marzia Vastano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
| | - Francesco Baccelli
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Giulia Gallotta
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Laura Bruni
- Specialty School of Paediatrics, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (F.B.); (G.G.); (L.B.)
| | - Adelaide Corvaglia
- School of Medicine, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy;
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy; (T.G.); (S.P.); (C.C.); (M.V.); (M.L.)
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22
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Anfigeno L, Sertorio F, Basso L, Fontana A, Bodria M, Pistorio A, Ghiggeri GM, Damasio MB. Diffusion-Weighted MRI in the Evaluation of Renal Parenchymal Involvement during Febrile Urinary Tract Infections in Children: Preliminary Data. J Clin Med 2021; 10:jcm10112239. [PMID: 34064114 PMCID: PMC8196731 DOI: 10.3390/jcm10112239] [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: 04/03/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary tract infection (UTI) is the most common infection in pediatric-age patients. Acute pyelonephritis (PNA) represents a worrying situation in pediatric patients due to the risk of sepsis and long-term cicatricial consequences. The purpose of this retrospective study is to evaluate the diagnostic role of DW-MRI in relation to clinical data, to understand if there are any clinical parameters useful in identifying which patients should undergo it. Methods: According to inclusion and exclusion criteria, we enrolled 51 patients ≤15 years old admitted to our Institute between September 2012 and April 2020 with a febrile UTI who underwent DW-MRI evaluation. Clinical, laboratory and imaging data were collected. Statistical analysis was performed. Results: 34 of 51 patients with an fUTI (66.7%) showed signs of acute parenchymal involvement at DW-MRI evaluation. In 27 of these 34 (79.4%), DW-MRI showed multiple areas of pyelonephritis. A statistically significant relationship (p = 0.0004) between older age at admission and pyelonephritis was demonstrated. No statistically significant relationship was found between the other clinical, anamnestic and laboratory parameters and the outcome of DWI. Only two ultrasound examinations allowed the identification of pathological areas on the renal parenchyma. Conclusions: From these preliminary investigations, we can say that selecting the patients with fUTI on whom to perform a DW-MRI is difficult. Nevertheless, thanks to the low cost, the very rare need for sedation and the accuracy in identifying pyelonephritic areas, the use of DW-MRI in patients with febrile UTI seems recommendable.
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Affiliation(s)
- Lorenzo Anfigeno
- Department of Health Sciences (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
- Correspondence:
| | - Fiammetta Sertorio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Luca Basso
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Andrea Fontana
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Monica Bodria
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Angela Pistorio
- Epidemiology and Biostatistics Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Gian Marco Ghiggeri
- Nephrology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Maria Beatrice Damasio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
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23
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Diffusion-Weighted MRI in the Evaluation of Renal Parenchymal Involvement during Febrile Urinary Tract Infections in Children: Preliminary Data. J Clin Med 2021. [DOI: 10.3390/jcm10112239
expr 943224684 + 995609622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common infection in pediatric-age patients. Acute pyelonephritis (PNA) represents a worrying situation in pediatric patients due to the risk of sepsis and long-term cicatricial consequences. The purpose of this retrospective study is to evaluate the diagnostic role of DW-MRI in relation to clinical data, to understand if there are any clinical parameters useful in identifying which patients should undergo it. Methods: According to inclusion and exclusion criteria, we enrolled 51 patients ≤15 years old admitted to our Institute between September 2012 and April 2020 with a febrile UTI who underwent DW-MRI evaluation. Clinical, laboratory and imaging data were collected. Statistical analysis was performed. Results: 34 of 51 patients with an fUTI (66.7%) showed signs of acute parenchymal involvement at DW-MRI evaluation. In 27 of these 34 (79.4%), DW-MRI showed multiple areas of pyelonephritis. A statistically significant relationship (p = 0.0004) between older age at admission and pyelonephritis was demonstrated. No statistically significant relationship was found between the other clinical, anamnestic and laboratory parameters and the outcome of DWI. Only two ultrasound examinations allowed the identification of pathological areas on the renal parenchyma. Conclusions: From these preliminary investigations, we can say that selecting the patients with fUTI on whom to perform a DW-MRI is difficult. Nevertheless, thanks to the low cost, the very rare need for sedation and the accuracy in identifying pyelonephritic areas, the use of DW-MRI in patients with febrile UTI seems recommendable.
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24
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Campbell A, Hartling L, Louie-Poon S, Scott SD. Exploring the Experiences and Information Needs of Parents Caring for a Child With a Urinary Tract Infection: A Qualitative Study. J Patient Exp 2021; 8:23743735211008299. [PMID: 34179429 PMCID: PMC8205397 DOI: 10.1177/23743735211008299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infections (UTIs) are common in children, however, clinical
practice variations can leave parents unsure how to care for their child. We aim
to develop knowledge tools that provide evidence-based information about
pediatric UTIs. To inform tool development, we asked parents to share their
experiences and information needs in caring for a child with a UTI. Using
qualitative description methods, 16 semistructured interviews were conducted
with 18 parents. Parents were recruited through the emergency department (ED) of
a major Canadian urban pediatric hospital. Five major themes emerged: (1) parent
descriptions of their child’s symptoms and behaviors; (2) UTIs have an effect on
the entire family; (3) reasons for going to the ED; (4) parent experiences with
UTI treatment, management, and follow-up strategies for their child; and (5)
parent information needs and preferred information sources for UTIs. Our
findings highlight the diversity of UTI symptoms children experience, which
causes uncertainty and confusion for parents. This diversity suggests the
development of knowledge tools for parents about UTIs is needed.
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Affiliation(s)
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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25
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Early conversion of intravenous to oral antibiotic therapy in uncomplicated urinary and respiratory tract infection. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Albarrak M, Alzomor O, Almaghrabi R, Alsubaie S, Alghamdi F, Bajouda A, Nojoom M, Faqeehi H, Rubeea SA, Alnafeesah R, Dolgum S, ALghoshimi M, AlHajjar S, AlShahrani D. Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2021; 8:57-67. [PMID: 34084874 PMCID: PMC8144855 DOI: 10.1016/j.ijpam.2021.03.001] [Citation(s) in RCA: 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: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 10/25/2022]
Abstract
Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Alzomor
- Pediatric Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rana Almaghrabi
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sarah Alsubaie
- Department of Pediatrics, College of medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Faisal Alghamdi
- Pediatric Emergency, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.,Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asrar Bajouda
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha Nojoom
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Faqeehi
- Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Subhy Abo Rubeea
- Pediatric Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Alnafeesah
- General Pediatric Department, Alyammamh Hospital, Riyadh, Saudi Arabia
| | - Saeed Dolgum
- Pediatric Infectious Diseases, Dr.Suliman ALhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed ALghoshimi
- General Pediatrics Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami AlHajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dayel AlShahrani
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Mouanga Ndzime Y, Onanga R, Kassa Kassa RF, Bignoumba M, Mbehang Nguema PP, Gafou A, Lendamba RW, Mbombe Moghoa K, Bisseye C. Epidemiology of Community Origin Escherichia coli and Klebsiella pneumoniae Uropathogenic Strains Resistant to Antibiotics in Franceville, Gabon. Infect Drug Resist 2021; 14:585-594. [PMID: 33623399 PMCID: PMC7896796 DOI: 10.2147/idr.s296054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Urinary tract infection is one of the major causes of consultation, microbiologic exploration, intensive use of antibiotics worldwide, and the second leading cause of clinical consultation in community practice. Many bacteria play a role in the urinary tract infections etiology, including Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella spp. Objective The study’s main objective was to examine the epidemiology of E. coli and Klebsiella pneumoniae (K. pneumoniae) uropathogenic strains resistant to antibiotics in Franceville. Methodology The study was carried out between January 2018 and June 2019 in Franceville South-East Gabon. We examined a total of 1086 cytobacteriological urine samples. The identification of E. coli and K. pneumoniae strains was carried out using the Vitek-2 compact automated system and the antibiogram with the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Results The prevalence of urinary tract infections was 29.2% (317/1086), of which 25.1% and 4.1% were mono-infections and co-infections, respectively. The prevalence of UTIs with E. coli was 28.7% (91/317) with a predominance of isolation in women. K. pneumoniae was responsible for 16.2% (61/317) of UTIs. E. coli and K. pneumoniae Uropathogenic strains showed resistance to beta-lactams, quinolones and cotrimoxazole, whereas Nitrofurantoin, Amikacin, Imipenem and Ertapenem were the most active antibiotics against E. coli and K. pneumoniae uropathogenic strains. Conclusion This study showed a high prevalence of urinary tract infections with a major implication of E.coli and K. pneumoniae strains. E. coli and K. pneumoniae presented high frequency of resistance to antibiotics, highlighting the need to adapt their use accordingly at the local level.
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Affiliation(s)
- Yann Mouanga Ndzime
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
| | - Richard Onanga
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roland Fabrice Kassa Kassa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Michelle Bignoumba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Pierre Philippe Mbehang Nguema
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Institut de Recherche en Ecologie Tropicale, Centre National de la Recherche Scientifique et Technologique (CENAREST), Libreville, BP 13354, Gabon
| | - Amahani Gafou
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roméo Wenceslas Lendamba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Kelly Mbombe Moghoa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
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Fenta A, Dagnew M, Eshetie S, Belachew T. Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot comprehensive and specialized hospital, Northwest Ethiopia. A prospective study. BMC Infect Dis 2020; 20:673. [PMID: 32938424 PMCID: PMC7493977 DOI: 10.1186/s12879-020-05402-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background Urinary tract infection is one of the most common bacterial infections in children. Understanding the characteristics of uropathogens and their antimicrobial susceptibility pattern in a particular setting can provide evidence for the appropriate management of cases. This study aimed to assess the bacterial profile of urinary tract infection, their antimicrobial susceptibility pattern and associated factors among clinically suspected children attending at Felege-Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted from February–April, 2019. A systematic sampling technique was employed. A mid-stream urine sample was inoculated on cystine lactose electrolyte deficient media and incubated for 24–48 h. Sub-culturing was done on Mac-Conkey and blood agar. Antimicrobial susceptibility test was done on Muller-Hinton agar. A binary logistic regression model was used to see the association between dependent and independent factors. A p-value< 0.05 at 95% CI was considered as statistically significant. Results The overall prevalence of urinary tract infection was 16.7% (95% CI 12.4–21.1). Both Gram-negative and Gram-positive bacterial isolates were recovered with a rate of 44/50 (88%) and 6/50 (12%) respectively. Among Gram-negative isolates, E. coli 28/44(63.6%) was predominant while S. saprophyticus 2/6(33.3%) was prevalent among Gram-positive bacterial isolates. Overall, a high level of resistance to ampicillin, augmentin, and tetracycline was shown by Gram-negative bacteria with a rate of 44/44(100%), 39/44(88.6%), and36/44 (81.8%) respectively. About 33/50(66%) of overall multidrug resistance was observed (95% CI 52–78). About six Gram-negative bacterial isolates were extended spectrum beta-lactamase (ESBL) producers. Having a history of urinary tract infection (P-0.003, AOR 1.86–22.15) and male uncircumcision (p-0.00, AOR 5.5–65.35) were the independent variables that associate for urinary tract infections. Conclusion In the present study, the prevalence of urinary tract infection among children was high and considerably a high proportion of multidrug resistance was observed. This result will have a significant impact on the selection of appropriate antimicrobial agents for the treatment of urinary tract infection.
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Affiliation(s)
- Adugna Fenta
- Wogera primary hospital, North Gondar, Gondar, Ethiopia
| | - Mulat Dagnew
- College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Setegn Eshetie
- College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Teshome Belachew
- College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia.
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Tufon KA, Fokam DPY, Kouanou YS, Meriki HD. Case report on a swift shift in uropathogens from Shigella flexneri to Escherichia coli: a thin line between bacterial persistence and reinfection. Ann Clin Microbiol Antimicrob 2020; 19:31. [PMID: 32727466 PMCID: PMC7392695 DOI: 10.1186/s12941-020-00374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Urinary tract infections (UTI) are mostly caused by bacteria. Urine cultures are usually a definitive measure to select the appropriate antibiotics for the elimination of a uropathogen and subsequent recovery from the infection. However, the preferred antibiotics as determined by urine culture and sensitivity may still not eliminate the infection and would require further examination to ascertain the cause of treatment failure which could be unresolved bacteriuria, bacterial persistence, immediate reinfection with a different uropathogen or misdiagnosis. Case presentation A 2-years 7 months-old female was admitted in the Regional hospital of Buea following persistent fever. An auto medication with amoxicillin was reported. Urinalysis was done on the first day and the sediment of the cloudy urine revealed many bacteria and few pus cells. Ceftriaxone was prescribed as empirical treatment and a request for urine and blood culture was made. Three days after admission, the temperature and CRP were 39.0 °C and 96 mg/l, respectively. The urine culture results (> 105 CFU/ml of Shigella flexneri sensitive to ofloxacin) were presented to the doctor on the 4th day of admission. Patient was put on ofloxacin. Three days after, the temperature (38.5 °C) and CRP (24 mg/l) were still elevated. The blood culture result came out negative. A second urine culture was requested which came back positive (> 105 CFU/ml of Escherichia coli resistant to ofloxacin and sensitive to meropenem and amikacin). Ofloxacin was discontinued and the patient put on meropenem and amikacin. The third urine culture recorded no significant growth after 48 h of incubation. The patient was discharged looking healthy once more with a normal body temperature. Conclusion Antibiotics tailored towards the elimination of a particular bacterial species may as well provide a favorable environment for other bacterial species that are resistant to it in the course of treating a UTI episode. This apparent treatment failure may first of all require a second urine culture for confirmation rather than considering the possibilities of a misdiagnosis.
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Affiliation(s)
- Kukwah Anthony Tufon
- Buea Regional Hospital, Southwest Region, Buea, Cameroon. .,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon. .,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.
| | - Djike Puepi Yolande Fokam
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Internal Medicine and Paediatrics, Faculty of Health Science, University of Buea, Buea, Cameroon
| | | | - Henry Dilonga Meriki
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon.,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
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30
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Fox MT, Amoah J, Hsu AJ, Herzke CA, Gerber JS, Tamma PD. Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis. JAMA Netw Open 2020; 3:e203951. [PMID: 32364593 PMCID: PMC7199115 DOI: 10.1001/jamanetworkopen.2020.3951] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE National guidelines recommend treating children with pyelonephritis for 7 to 14 days of antibiotic therapy, yet data are lacking to suggest a more precise treatment duration. OBJECTIVE To compare the clinical outcomes of children receiving a short-course vs a prolonged-course of antibiotic treatment for pyelonephritis. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study using inverse probability of treatment weighted propensity score analysis of data from 5 hospitals in Maryland between July 1, 2016, and October 1, 2018. Participants were children aged 6 months to 18 years with a urine culture growing Escherichia coli, Klebsiella species, or Proteus mirabilis with laboratory and clinical criteria for pyelonephritis. EXPOSURES Treatment of pyelonephritis with a short-course (6 to 9 days) vs a prolonged-course (10 or more days) of antibiotics. MAIN OUTCOMES AND MEASURES Composite outcome of treatment failure within 30 days of completing antibiotic therapy: (a) unanticipated emergency department or outpatient visits related to urinary tract infection symptoms, (b) hospital readmission related to UTI symptoms, (c) prolongation of the planned, initial antibiotic treatment course, or (d) death. A subsequent urinary tract infection caused by a drug-resistant bacteria within 30 days was a secondary outcome. RESULTS Of 791 children who met study eligibility criteria (mean [SD] age 9.2 [6.3] years; 672 [85.0%]) were girls, 297 patients (37.5%) were prescribed a short-course and 494 patients (62.5%) were prescribed a prolonged-course of antibiotics. The median duration of short-course therapy was 8 days (interquartile range, 7-8 days), and the median duration of prolonged-course therapy was 11 days (interquartile range, 11-12 days). Baseline characteristics were similar between the groups in the inverse probability of treatment weighted cohort. There were 79 children (10.1%) who experienced treatment failure. The odds of treatment failure were similar for patients prescribed a short-course vs a prolonged-course of antibiotics (11.2% vs 9.4%; odds ratio, 1.22; 95% CI, 0.75-1.98). There was no significant difference in the odds of a drug-resistant uropathogen for patients with a subsequent urinary tract infection within 30 days when prescribed a short-courses vs prolonged-course of antibiotics (40% vs 64%; odds ratio, 0.36; 95% CI, 0.09-1.43). CONCLUSIONS AND RELEVANCE The study findings suggest that short-course antibiotic therapy may be as effective as prolonged-courses for children with pyelonephritis, and may mitigate the risk of future drug-resistant urinary tract infections. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Miriam T. Fox
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joe Amoah
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice J. Hsu
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Carrie A. Herzke
- Department of Medicine and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey S. Gerber
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pranita D. Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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31
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Lee YJ, Kim KM, Jung HL, Shim JY, Kim DS, Shim JW. Relationship between Breastfeeding, Birth History, and Acute Pyelonephritis in Infants. J Korean Med Sci 2020; 35:e32. [PMID: 32103642 PMCID: PMC7049624 DOI: 10.3346/jkms.2020.35.e32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/11/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although the clinical importance of the immunological benefits of breastfeeding has been emphasized for decades, their direct relationship with acute pyelonephritis (APN) is still not clear. Our goal was to determine whether breastfeeding truly provides protection against APNs, while investigating the effects of other factors such as sex, age, mode of delivery, and birth weight on APN. METHODS A total of 62 infants under 6 months of age who had both microbiologically and radiologically-confirmed APN were enrolled in the case group. Healthy infants (n = 178) who visited the hospital for scheduled vaccinations were enrolled in the control group. The following participant characteristics were compared between the case and control groups: age, sex, birth order among siblings, feeding methods, weight percentile by month, birth weight percentile by gestational age, gestational age at birth, and mode of delivery. RESULTS Babies exclusively fed with manufactured infant formulae before 6 months of age had significantly higher risk for APN than breastfed or mixed-fed infants (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.687-7.031; P = 0.001). Firstborn babies had lower risk for APN than 2nd- or 3rd-born babies (OR, 0.43; 95% CI, 0.210-0.919). Other factors that increased the risk for APN were low birth weight percentiles (OR, 8.33; 95% CI, 2.300-30.166) and birth via caesarean section (OR, 2.32; 95% CI, 1.097-4.887). There were more preterm births in the case group (10.9% vs. 1.7%; P = 0.002), but this did not increase the risk for APN (OR, 4.47; P = 0.063). CONCLUSION Feeding exclusively with formula before 6 months of age was related to higher risk for APN, which demonstrates that breastfeeding has a protective effect against APN. The other risk factors for APN were birth order (≥ 2nd-born), low birth weight, and birth via caesarean section.
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Affiliation(s)
- Young Ju Lee
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Moon Kim
- Department of Pediatrics, Hwacheon Health Center and County Hospital, Hwacheon, Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Soo Kim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Urinary Tract Infections With Extended-spectrum-β-lactamase-producing Bacteria: Case-control Study. Pediatr Infect Dis J 2020; 39:211-216. [PMID: 32032306 DOI: 10.1097/inf.0000000000002531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are the most common bacterial infections among infants and young children with fever without a source. Extended-spectrum β-lactamases (ESBLs) have emerged as emerging cause of UTI globally; however, data about risk factors and clinical features of children with ESBL-UTI have been scarce. OBJECTIVE To describe the predisposing risk factors, clinical and microbiologic features associated with pediatric UTIs caused by ESBL-producing bacteria (ESBL-PB). METHODS Our nested case-control study ran from January 1, 2012 to December 31, 2016. Pediatric patients with ESBL-PB UTI were compared with patients with non-ESBL-PB UTI matched for age and year of diagnosis. RESULTS A total of 720 children were enrolled (240 cases and 480 controls). Patients with ESBL-PB UTI were more likely to have a history of prior intensive care unit (ICU) admission (22.5% vs. 12.3%, P < 0.001), at least one underlying comorbidity (19.2% vs. 5.8%, P < 0.001), prior hospitalization (47.1% vs. 32.9%, P < 0.001), exposure to a cephalosporin antibiotic within 30 days before culture (7.5% vs. 4.2%, P = 0.035), and to have cystostomy (7.9% vs. 1.5%, P < 0.001) compared with those with non-ESBL-PB UTI. Patients with ESBL-PB UTI were more likely to present with hypothermia (48.8% vs. 38.5%, P = 0.009); had significantly longer average hospital stays {8.7 days [95% confidence interval (CI): 3.2-14.3] vs. 4.0 days (95% CI: 2.5-5.5)} and were more likely to be admitted to the ICU [odds ratio (OR) 1.8; 95% CI: 1.1-2.9). Multivariate analysis determined that only having cystostomy (OR 3.7; 95% CI: 1.4-9.4] and at least one underlying comorbidity (OR 2.4; 95% CI: 1.3-4.3) were the independent risk factors for ESBL-PB UTI. All ESBL-PB isolates tested against meropenem were susceptible, majority were resistant to multiple non-beta-lactam antibiotics. CONCLUSIONS Children with underlying comorbidities and cystostomy are at higher risk for ESBL-PB UTI, but majority of ESBL cases were patients without any known risk factors. Clinical signs/symptoms and commonly used biochemical markers were unreliable to differentiate cases caused by ESBL-PB from those caused by non-ESBL-PB. Further research is needed to elucidate the conditions most associated with ESBL-PB UTIs among children to properly guide empirical therapy in patients at-risk for these infections, to improve the outcomes, and finally, to determine strategies for rational antimicrobial use.
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Agafonova EV, Rizvanova FF, Malanicheva TG, Abrahamyan L. Activation Markers and Regulatory T cells in Children with Chronic Pyelonephritis Associated with Bacterial Uropathogens. BIONANOSCIENCE 2020. [DOI: 10.1007/s12668-019-00676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Fusco NM, Nichols K. Common bacterial infections and their treatment in hospitalized pediatric patients. Am J Health Syst Pharm 2020; 76:1521-1531. [PMID: 31532502 DOI: 10.1093/ajhp/zxz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided. SUMMARY Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use. CONCLUSION Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring.
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Affiliation(s)
- Nicholas M Fusco
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY
| | - Kristen Nichols
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
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Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary Tract Infection in Children. ACTA ACUST UNITED AC 2020; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Alsubaie SS, Barry MA. Current status of long-term antibiotic prophylaxis for urinary tract infections in children: An antibiotic stewardship challenge. Kidney Res Clin Pract 2019; 38:441-454. [PMID: 31739385 PMCID: PMC6913590 DOI: 10.23876/j.krcp.19.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022] Open
Abstract
Recurrent urinary tract infections (UTIs) in children are associated with development of pyelonephritis and renal scarring. Traditionally, continuous antibiotic prophylaxis (CAP) has been used to prevent recurrent UTI. Recent studies have challenged the efficacy of CAP for preventing renal scarring and have raised concerns about inducing bacterial resistance. This review focuses on studies published between January 2000 and April 2019 and evaluates the use of CAP in children for avoiding recurrent UTIs and renal scarring. A systematic literature search was carried out using the following search terms and related medical subject headings in the MEDLINE electronic database: ‘urinary tract infection’, ‘antimicrobial/antibiotic prophylaxis’, and ‘children/pediatrics’. Randomized clinical trials (RCTs), original research articles, guidelines, systematic reviews, and meta-analyses describing antibiotic prophylaxis for UTIs were included. A total of 34 RCTs, 9 systematic reviews, and 3 guidelines describing antibiotic prophylaxis were included in this review. The efficacy of CAP for preventing recurrent UTI remains unclear due to non-generalizability of results obtained from suboptimally designed clinical trials. CAP has not been proven as beneficial for preventing new renal scarring in children. Additionally, CAP is associated with increased risk of multidrug resistant infections in children. No conclusive evidence can be drawn from the available clinical data to support routine use of CAP for prevention of renal scarring. Accumulation of evidence from additional well designed studies may result in different conclusions in the future. It is important to identify specific risks for recurrent UTI and ensuing renal injury to ensure more judicious use of CAP.
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Affiliation(s)
- Sarah S Alsubaie
- Pediatric Infectious Diseases Unit, Department of Pediatrics, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mazin A Barry
- Infectious Diseases Unit, Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Jung JH, Hong HJ, Gharderpour A, Cho JY, Baek BS, Hur Y, Kim BC, Kim D, Seong SY, Lim JY, Seo SU. Differential interleukin-1β induction by uropathogenic Escherichia coli correlates with its phylotype and serum C-reactive protein levels in Korean infants. Sci Rep 2019; 9:15654. [PMID: 31666593 PMCID: PMC6821743 DOI: 10.1038/s41598-019-52070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/13/2019] [Indexed: 12/29/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections in infants less than age 1 year. UTIs frequently recur and result in long-term effects include sepsis and renal scarring. Uropathogenic Escherichia coli (UPEC), the most prevalent organism found in UTIs, can cause host inflammation via various virulence factors including hemolysin and cytotoxic necrotizing factors by inducing inflammatory cytokines such as interleukin (IL)-1β. However, the ability of each UPEC organism to induce IL-1β production may differ by strain. Furthermore, the correlation between differential IL-1β induction and its relevance in pathology has not been well studied. In this study, we isolated UPEC from children under age 24 months and infected bone-marrow derived macrophages with the isolates to investigate secretion of IL-1β. We found that children with higher concentrations of C-reactive protein (CRP) were more likely to harbor phylotype B2 UPEC strains that induced more IL-1β production than phylotype D. We also observed a significant correlation between serum CRP level and in vitro IL-1β induction by phylotype B2 UPEC bacteria. Our results highlight the diversity of UPEC in terms of IL-1β induction capacity in macrophages and suggest a potential pathogenic role in UTIs by inducing inflammation in infants.
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Affiliation(s)
- Jong-Hyeok Jung
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Gangwon-do, Republic of Korea
| | - Hyun Jung Hong
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Aziz Gharderpour
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Gangwon-do, Republic of Korea
| | - Jae Young Cho
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Bum-Seo Baek
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Gangwon-do, Republic of Korea
| | - Yong Hur
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byoung Choul Kim
- Division of Nano-bioengineering, Incheon National University, Incheon, Republic of Korea
| | - Donghyun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Microbiology and Immunology, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Yong Seong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Gangwon-do, Republic of Korea.,Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Microbiology and Immunology, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-do, Republic of Korea. .,Gyeongsang Institute of Health Science, Jinju, Gyeongsangnam-do, Republic of Korea.
| | - Sang-Uk Seo
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Gangwon-do, Republic of Korea. .,Mucosal Immunology Laboratory, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Rakhra J, Williams G, Marais BJ, Craig JC, Gunasekera H. Urinary tract infections in febrile children: Changing spectra of pathogenic bacteria and antibiotic susceptibilities? J Paediatr Child Health 2019; 55:680-689. [PMID: 30324735 DOI: 10.1111/jpc.14275] [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: 03/12/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
AIM To compare the spectra of pathogens causing febrile urinary tract infections (UTI) in children, treatment and antimicrobial susceptibility between 2004-2006 and 2007-2009. METHODS UTI were identified from a cohort study of febrile children younger than 5 years presenting to a large tertiary children's hospital's emergency department with febrile illnesses. We compared pathogenic profiles, antibiotic choices and susceptibilities between 2004-2006 and 2007-2009 and tested for differences using χ2 and Fisher's exact tests. Antibiotic choice was compared with national therapeutic guideline recommendations for UTI in children (oral cotrimoxazole, cephalexin or amoxycillin-clavulanate or intravenous gentamicin plus ampicillin). RESULTS There were 539 (2.71%) confirmed UTI from 19 889 febrile illnesses in 2004-2006 and 654 (2.99%) confirmed UTI from 21 846 febrile illnesses in 2007-2009. There was no difference in the frequency of the isolated pathogens by period: Escherichia coli (69.2 vs. 69.7%, P = 0.85), Proteus mirabilis (7.9 vs. 7.2%, P = 0.66) and Klebsiella species (6.2 vs. 4.7%, P = 0.25). National therapeutic guideline recommendations were followed in 277 of 539 (51.4%) versus 318 of 654 (48.6%) (P = 0.34). Oral antibiotics were given in 20.6 versus 18.9%. There was no difference in extended spectrum beta lactamase (1.5 vs. 1.7%, P = 0.82) or other antibiotic susceptibilities (e.g. E. coli: cotrimoxazole = 75.9 vs. 75.2%, P = 0.8). CONCLUSIONS Overall, approximately 3% of febrile illnesses were due to UTI, but we found no change in the spectrum of pathogens or antibiotic susceptibility patterns, including extended-spectrum beta-lactamase, with time. In both time periods, treatment followed therapeutic guidelines approximately half the time, and most pathogens were susceptible to oral antibiotics, but they were infrequently used.
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Affiliation(s)
- Jus Rakhra
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gabrielle Williams
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Marais
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Balbas-Martinez V, Michelet R, Edginton AN, Meesters K, Trocóniz IF, Vermeulen A. Physiologically-Based Pharmacokinetic model for Ciprofloxacin in children with complicated Urinary Tract Infection. Eur J Pharm Sci 2018; 128:171-179. [PMID: 30503378 DOI: 10.1016/j.ejps.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 01/05/2023]
Abstract
In a recent multicenter population pharmacokinetic study of ciprofloxacin administered to children suffering from complicated urinary tract infection (cUTI), the apparent volume of distribution (V) and total plasma clearance (CL) were decreased by 83.6% and 41.5% respectively, compared to healthy children. To understand these differences, a physiologically-based pharmacokinetic model (PBPK) for ciprofloxacin was developed for cUTI children. First, a PBPK model in adults was developed, modified incorporating age-dependent functions and evaluated with paediatric data generated from a published model in healthy children. Then, the model was then adapted to a cUTI paediatric population according to the degree of renal impairment (KF) affecting renal clearance (CLRenal,) and CYP1A2 clearance (CLCYP1A2). Serum and urine samples obtained from 22 cUTI children were used for model evaluation. Lastly, a parameter sensitivity analysis identified the most influential parameters on V and CL. The PBPK model predicted the ciprofloxacin exposure in adults and children, capturing age-related pharmacokinetic changes. Plasma concentrations and fraction excreted unchanged in urine (fe) predictions improved in paediatric cUTI patients once CLrenal and CLCYP1A2 were corrected by KF. The presented PBPK model for ciprofloxacin demonstrates its adequacy to simulate different dosing scenarios to obtain PK predictions in a healthy population from 3 months old onwards. Model adaptation of CLRenal and CLCYP1A2 according to KF explained partially the differences seen in the plasma drug concentrations and fe vs time profiles between healthy and cUTI children. Nevertheless, it is necessary to further investigate the disease-related changes in cUTI to improve model predictions.
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Affiliation(s)
- Violeta Balbas-Martinez
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
| | - Robin Michelet
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kevin Meesters
- Ghent University Hospital, Department of Pediatric Nephrology, Ghent, Belgium; KidZ Health Castlee, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Iñaki F Trocóniz
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - An Vermeulen
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
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Bignall ONR, Dixon BP. Management of Hematuria in Children. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:333-349. [PMID: 30128264 PMCID: PMC6097192 DOI: 10.1007/s40746-018-0134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose of Review This paper provides a review of the diagnostic evaluation of both microscopic and gross hematuria, as well as an update on the pathogenesis, clinical features, and treatment strategies for several diseases of the kidneys and urinary tract in which hematuria is a prominent finding. The goal is to provide pediatric providers with a framework through which appropriate and expeditious referral to subspecialty care may be made for definitive treatment. Recent Findings Although there has been great heterogeneity in published treatment strategies for many causes of hematuria, the Kidney Diseases Improving Global Outcomes (KDIGO) initiative has recently set forth guidelines for glomerular diseases in particular to provide evidence-based strategies for treatment. In addition, recent advances in the understanding of molecular pathogenesis and long-term clinical outcomes for other non-glomerular diseases has led to updates in treatment strategies summarized in this review. Summary As the pediatric primary care provider is often the first point of contact for children with microscopic or gross hematuria, updated knowledge as to the epidemiology and management of several of the various causes of hematuria will improve the care of children by both avoiding extraneous testing and interventions and implementing definitive care (either by expectant management and reassurance or by subspecialty referral) in a timely manner.
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Affiliation(s)
- O N Ray Bignall
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center
| | - Bradley P Dixon
- Renal Section, Department of Pediatrics, University of Colorado School of Medicine
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Gates A, Shulhan J, Featherstone R, Scott SD, Hartling L. A systematic review of parents' experiences and information needs related to their child's urinary tract infection. PATIENT EDUCATION AND COUNSELING 2018; 101:1207-1215. [PMID: 29395475 DOI: 10.1016/j.pec.2018.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE As a first step toward the development of an animated video and infographic to increase parents' knowledge of pediatric urinary tract infections (UTIs), we conducted a systematic review of their experiences and information needs. METHODS We searched Ovid Medline, Ovid PsycINFO, CINAHL, and ProQuest Dissertations and Theses Global for studies published in 2000 or thereafter. We appraised quality using the Mixed Methods Appraisal Tool. We summarised the quantitative data narratively and the qualitative data thematically. RESULTS We identified 1493 records and included four. Sample size ranged from 20 to 2726 parents. The children ranged from <1 to 12 years old and had experienced one to >10 UTIs. Parents were not always aware of UTI symptoms and generally received little information. Parents sought information online, and desired it via other means. Some parents were not confident in healthcare providers' (HCPs') knowledge of UTIs. Inadequate information about diagnostic tests sometimes resulted in fear and non-compliance. CONCLUSIONS From the limited literature, it appears that parents would like information about prevention, diagnosis, treatment, and prognosis, but do not always consider HCPs good information sources. PRACTICE IMPLICATIONS Care providers should communicate information in ways that suit parents' self-identified needs.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Jocelyn Shulhan
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
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Dogan Z, Cetin A, Elibol E, Vardi N, Turkoz Y. Effects of ciprofloxacin and quercetin on fetal brain development: a biochemical and histopathological study. J Matern Fetal Neonatal Med 2018; 32:1783-1791. [PMID: 29241384 DOI: 10.1080/14767058.2017.1418222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Teratogens cause birth defects and malformations while human development is being completed. In pregnancy, urinary tract infection (UTI) is a common health problem caused by bacteria. The fluoroquinolones such as ciprofloxacin, levofloxacin, moxifloxacin, and gemifloxacin can treat various types of bacterial infections successfully. The aim of this study is to determine whether the use of ciprofloxacin during pregnancy causes oxidative stress on brain tissues of the fetus, and whether quercetin contributes to prevent this damage if stress has already occurred. MATERIALS AND METHODS In our study, 22 young female Wistar albino rats weighing 250 g were used. Rats were mated overnight in separate plastic cages. Female rats were regarded as pregnant when a vaginal plug was observed, and these were divided into four groups of control, ciprofloxacin, quercetin, and cipro + quercetin. Two daily i.p. 20 mg/kg doses of ciprofloxacin were administered to ciprofloxacin group between 7 and 17 d of pregnancy. Throughout the study, daily (20 d) 20 mg/kg quercetin was dissolved in corn oil and administered to the quercetin group by oral gavage. Rats were fed ad libitum throughout the study. Fetuses were taken by C-section on the 20th day of pregnancy. Thereafter, the brain tissues were subjected to histological assessments and biochemical analyzes. RESULTS The experimental groups were compared with the control group; ciprofloxacin affected fetal development, especially caused damage to neurons in brain tissue and cause hemorrhagic defects. And also, it was determined that many parameters were affected such as antioxidant parameters, enzyme levels and levels of malondialdehyde (MDA) (a marker of lipid peroxidation). Quercetin is a member of flavonoid with strong antioxidant properties, and our results indicate that the use of ciprofloxacin in pregnancy can result damage to fetal brain tissue. CONCLUSIONS Unlike these results when some parameters are evaluated it is understood that this harmful effects suppressed by quercetin.
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Affiliation(s)
- Zumrut Dogan
- a Department of Anatomy, Faculty of Medicine , Adiyaman University , Adiyaman , Turkey
| | - Aymelek Cetin
- b Department of Anatomy, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Ebru Elibol
- c Department of Histology and Embryology, Faculty of Medicine , Adiyaman University , Adiyaman , Turkey
| | - Nigar Vardi
- d Department of Histology and Embryology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Yusuf Turkoz
- e Department of Biochemistry, Faculty of Medicine , Inonu University , Malatya , Turkey
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Stolić B, Katanić R, Katanić N, Odalović D, Pribaković-Aritonović J, Odalović A, Stolić A, Radomirović D, Vujačić M, Ilić V. Urinary tract infections in children and pathogen resistance to antimicrobial drugs. PRAXIS MEDICA 2018. [DOI: 10.5937/pramed1802049s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Forster CS, Courter J, Jackson EC, Mortensen JE, Haslam DB. Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent Catheterization. J Pediatric Infect Dis Soc 2017; 6:332-338. [PMID: 29186590 PMCID: PMC5907884 DOI: 10.1093/jpids/piw056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/17/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Children undergoing CIC frequently have positive urine culture results and receive many antimicrobial agents. Subsequently, this population is at high risk for infections caused by antimicrobial-resistant bacteria. Resistant pathogens, such as vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and organisms that produce extended-spectrum β-lactamases (ESBLs), which are third-generation cephalosporin resistant (3GCR), are of particular concern. METHODS In this retrospective study, all urine culture results and antimicrobial-susceptibility testing results were obtained between January 2008 and December 2014 from the electronic health record of children ≤18 years of age who were undergoing CIC (n = 14 832). Isolates were identified as VRE, CRE, or 3GCR. Organisms of the same type that were obtained in the same year and with identical antibiotic susceptibilities from the same patient were excluded. Simple linear regression was used to determine the association between year and rates of resistance. RESULTS A total of 3997 positive culture results were included in this analysis. Of all Enterococcus isolates for which susceptibility results were available, 4.6% were VRE, 11.1% of all isolates that belonged to the Enterobacteriaceae family were 3GCR, and 0.4% of eligible isolates were CRE. There were significantly higher rates of resistance to third-generation cephalosporins and CRE in 2014 than in 2008 (P < .01). Simple linear regression revealed a significant association between year and rate for resistance to third-generation cephalosporins but not for CRE or VRE. The rate of increase in resistance to third-generation cephalosporins in patients who required CIC was higher than that in patients who did not need CIC. CONCLUSIONS The rate of resistance to third-generation cephalosporins has increased significantly in the past 7 years in children undergoing CIC, which indicates that careful monitoring is warranted for continued increases in antimicrobial-resistant organisms in this unique patient population.
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Affiliation(s)
- Catherine S Forster
- Department of Pediatrics,Corresponding Author: Catherine S. Forster, MD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 9016, Cincinnati, OH 45229. E-mail:
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Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017; 37:273-279. [PMID: 28978286 DOI: 10.1080/20469047.2017.1382046] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Urinary tract infections (UTI) are one of the most common and serious bacterial infections encountered by paediatricians and primary care physicians. Although the diagnosis and management of UTI appear simplistic, they remain among the most contentious issues in paediatrics. In part, UTI controversies stem from the absence of classic clinical symptoms, inappropriate urine specimen collection, modified urinary tract imaging recommendations, and diverse treatment and prevention strategies. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent UTI in the paediatric and adolescent populations.
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Affiliation(s)
- Lindsey Korbel
- a Pediatrics Residency Program , Nationwide Children's Hospital , Columbus , OH , USA
| | - Marianella Howell
- b Department of Pediatrics, Division of Nephrology , Hospital Nacional de Niños , San Jose , Costa Rica
| | - John David Spencer
- c Department of Pediatrics, Division of Nephrology , Nationwide Children's Hospital , Columbus , OH , USA.,d Center for Clinical and Translational Research , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA
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Bayliss JK, Bodarya K, Carson CM, Miller BJ. Recurrent urinary tract infections in children and adolescents with acute psychosis. Schizophr Res 2017; 184:103-104. [PMID: 27889385 DOI: 10.1016/j.schres.2016.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Jocelyn K Bayliss
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - Ketan Bodarya
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - Chelsea M Carson
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States.
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Uwaezuoke SN. Urinary Tract Infection in Children: Diagnostic and Prognostic Utility of Biomarkers. JOURNAL OF COMPREHENSIVE PEDIATRICS 2017; In Press. [DOI: 10.5812/compreped.59248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
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Urinary tract infections in children and adolescents with acute psychosis. Schizophr Res 2017; 183:36-40. [PMID: 27839914 DOI: 10.1016/j.schres.2016.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Schizophrenia is associated with increased infections. We previously found an association between urinary tract infection (UTI) and acute psychosis in adults. The aims of this study were to 1) evaluate the prevalence of UTI at the time of admission in children and adolescents with non-affective psychosis and psychotic depression versus those with non-psychotic major depressive disorder, and 2) compare demographic and clinical features between children and adolescents with acute psychosis with and without comorbid UTI. METHOD We performed a retrospective chart review of 227 subjects ages 10-18 who were hospitalized between 2005 and 2014 for an acute episode of DSM-IV non-affective psychosis (schizophrenia, schizoaffective disorder, psychosis NOS, or delusional disorder; n=80), major depressive disorder (MDD) with psychotic features (n=47); or MDD without psychotic features (n=100). RESULTS The prevalence of UTI was 20% in non-affective psychosis, 9% in MDD with psychotic features, and 13% in non-psychotic MDD. After controlling for potential confounders, UTI was 3.5 times more likely in subjects with non-affective psychosis than non-psychotic MDD (OR=3.5, 95% CI 1.3-9.2, p=0.01). Subjects with UTI had a higher prevalence of manic symptoms, but otherwise there were no associations between clinical characteristics and UTI in acute psychosis. CONCLUSIONS We found an association between UTIs and children and adolescents with acute non-affective psychosis. The results highlight the potential importance of screening for comorbid UTI in patients with acute psychosis.
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