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Prevalence of Risk Factors of Urinary Tract Infections in Infants and Children in Arak, Iran: A Cross-sectional Study. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-131333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Urinary tract infection (UTI) is one of the most common childhood infections. Urinary tract infections are divided into simple and complex types. If the bladder infection is not treated, it can cause secondary kidney infections, such as acute pyelonephritis, which can lead to kidney scar or permanent kidney damage. A significant percentage of patients of any age are re-infected after antimicrobial treatments during the first six months after the first period of UTI. Objectives: This research aimed to investigate the risk factors affecting UTI in infants and children hospitalized in Arak Amir Kabir Hospital in 2017-2018 to prevent UTI and its secondary complications. Methods: In this cross-sectional study, the data collection tool was a validated questionnaire to gather the child's demographic characteristics, including age, sex, type of nutrition, circumcision, age of circumcision, as well as information about fetal birth weight, chronic maternal diseases such as diabetes and stress, and residence place. The content validation method was used to determine the validity of the checklist, and the test-retest was used for reliability. Data were analyzed by SPSS version 22 software. Results: Sixty four percent of children had the normal ultrasound, while 22% had hydronephrosis and nephrolithiasis on ultrasound. The average thickness and size of the right kidney were 71.75 and 9.11, and those of the left kidney were 9.11 and 9.50, respectively. The most common microorganism was Escherichia coli. Conclusions: Given the importance of prevention and timely diagnosis and treatment of UTI to prevent kidney injuries, it is necessary to find UTI risk factors as the first step to preventing children from secondary kidney injuries.
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Isac R, Basaca DG, Olariu IC, Stroescu RF, Ardelean AM, Steflea RM, Gafencu M, Chirita-Emandi A, Bagiu IC, Horhat FG, Vulcanescu DD, Ionescu D, Doros G. Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract. CHILDREN-BASEL 2021; 8:children8070585. [PMID: 34356564 PMCID: PMC8304885 DOI: 10.3390/children8070585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.
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Affiliation(s)
- Raluca Isac
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Diana-Georgiana Basaca
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ioana-Cristina Olariu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ramona F. Stroescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Ist Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Andrada-Mara Ardelean
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ruxandra M. Steflea
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Mihai Gafencu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Adela Chirita-Emandi
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Iulia Cristina Bagiu
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Dan-Dumitru Vulcanescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Dan Ionescu
- Physical Education and Sports Department, Polytechnic University, 300223 Timișoara, Romania;
| | - Gabriela Doros
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
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Fahimi D, Khedmat L, Afshin A, Noparast Z, Jafaripor M, Beigi EH, Ghodsi M, Izadi A, Mojtahedi SY. Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study. BMC Infect Dis 2021; 21:189. [PMID: 33602159 PMCID: PMC7890627 DOI: 10.1186/s12879-021-05887-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. OBJECTIVE A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics. METHODS A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection. RESULTS Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis). CONCLUSION There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.
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Affiliation(s)
- Daryoosh Fahimi
- Children’s Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Noparast
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Jafaripor
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghodsi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Rivanowitch E, Nassar R, Kristal E, Shalev R, Fruchtman Y, Hazan G, Ling G, Melamed R, Leibovitz E. Urinary tract infection in young infants discharged from the emergency room with normal urinalysis. Acta Paediatr 2019; 108:745-750. [PMID: 30074636 DOI: 10.1111/apa.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
AIM We describe the clinical, microbiologic, therapeutic, and outcome characteristics of infants under three months of age with a positive urine culture reported after discharge from emergency department with normal urinalysis. METHODS We enrolled all infants with a urine culture obtained during an emergency room visit during 2004-2012, discharged without antibiotic therapy and subsequently reported with a positive urine culture. RESULTS Three hundred and ninety-three positive urine cultures were reported; 46/393 (11.7%, 42 in patients under two months of age) had positive urine cultures following normal urinalysis at first visit. Fifteen (33%) had positive urine cultures at second visit; 11/15 (73%) infants with second positive urine culture were under one month of age, eight were asymptomatic and seven had mild symptoms at second visit. Pathogens isolated in all 15 infants were identical between first and second visit. All 27 infants re-examined at second visit at the emergency room were hospitalised, completed sepsis work/up and received antibiotic treatment. None developed serious bacterial infections. CONCLUSION We propose a new management approach for young infants with normal urinalysis and positive urine culture and suggest restricting the management option including hospitalisation, sepsis work/up and antibiotic treatment at second visit only to infants under one month of age.
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Affiliation(s)
- Einat Rivanowitch
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Raouf Nassar
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Eyal Kristal
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Rotem Shalev
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Yariv Fruchtman
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Guy Hazan
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Galina Ling
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Rimma Melamed
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Eugene Leibovitz
- Department of Pediatrics; Soroka University Medical Center; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
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Yilmaz Y, Tekkanat Tazegun Z, Aydin E, Dulger M. Bacterial Uropathogens Causing Urinary Tract Infection and Their Resistance Patterns Among Children in Turkey. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e26610. [PMID: 27621929 PMCID: PMC5003060 DOI: 10.5812/ircmj.26610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
Background Urinary tract infection (UTI) is a common problem in infants and children, as well as adults. Objectives The aim of this study was to assess the most common bacterial uropathogens, their susceptibility, and resistance to antibiotics in children with UTI. Materials and Methods This study included 7,365 urine samples sent from various departments to the Kars state hospital microbiology laboratory between January 2012 and May 2014. Bacterial isolation from clinical samples was made using standard microbiological methods. Antibiotic susceptibilities were determined by disk diffusion, according to CLSI recommendations. Results Bacterial growth was obtained in 1,373 samples (18.5%). The percentage distributions of the isolates were as follows: Escherichia coli, 940 (68.5%); Proteus spp, 183 (13.3%); Staphylococcus spp, 85 (6.2%); Enterococcus spp, 65 (4.7%); Klebsiella, 62 (4.5%); Pseudomonas aeruginosa, 21 (1.5%); and other Gram-negative bacteria and Gram-positive bacteria, 17 (1.2%). UTIs were more prevalent, after two years of age, among females than males (P < 0.001). Conclusions The identification of the most common microorganisms causing infectious diseases and regional resistance patterns is important in order to determine the antimicrobial policies and infection control guidelines of hospitals.
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Affiliation(s)
- Yunus Yilmaz
- Department of Pediatrics, Kafkas University Training and Research Hospital, Kars, Turkey
- Corresponding Author: Yunus Yilmaz, Department of Pediatrics, Kafkas University Training and Research Hospital, Kars, Turkey. Tel: +90-5069090995, Fax: +90-4742251430, E-mail:
| | | | - Emsal Aydin
- Department of Infectious Diseases and Clinical Microbiology, Kafkas University Training and Research Hospital, Kars, Turkey
| | - Mahmut Dulger
- Department of Infectious Diseases and Clinical Microbiology, Kars Government Hospital, Kars, Turkey
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Gurevich E, Tchernin D, Schreyber R, Muller R, Leibovitz E. Follow-up after infants younger than 2 months of age with urinary tract infection in Southern Israel: epidemiologic, microbiologic and disease recurrence characteristics. Braz J Infect Dis 2015; 20:19-25. [PMID: 26607682 PMCID: PMC9425337 DOI: 10.1016/j.bjid.2015.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/14/2015] [Accepted: 09/11/2015] [Indexed: 12/04/2022] Open
Abstract
Background The timing of most recurrences after neonatal urinary tract infection is during the first year of life, with peak incidence 2–6 months after the initial infection. Information on the microbiologic characteristics of recurrent urinary tract infection episodes in relation to the microbiology of the initial episodes is limited. Objectives To analyze the epidemiologic/microbiological characteristics of 1st and recurrent urinary tract infection in infants <2 months of age. Methods A retrospective study including all infants <2 months of age with urinary tract infection admitted during 2005–2009 and followed till the age of 1 year. Results 151 neonates were enrolled (2.7% of all 5617 febrile infants <2 months of age admitted). The overall incidence of urinary tract infection occurring during the first 2 months of life was 151/73,480 (0.2%) live births during 2005–2009 in southern Israel (2.1 cases/1000 live births). One pathogen was isolated in 133 (88.1%); Escherichia coli, Klebsiella spp., Enterococcus spp., Morganella morganii, Proteus spp., and Enterobacter spp. represented the most common pathogens (57.9%, 12.2%, 7.9%, 6.7%, 6.1%, and 5%, respectively). Trimethoprim/sulfamethoxazole, ampicillin, and cefuroxime-axetil were the most commonly recommended prophylactic antibiotics (45%, 13.2%, and 8%, respectively). Twenty-three recurrent urinary tract infection episodes were recorded in 20 (13.2%) patients; 6/23 (26%) were diagnosed within one month following 1st episode. E. coli was the most frequent recurrent urinary tract infection pathogen (12/23, 52.2%). No differences were recorded in E. coli distribution between first urinary tract infection vs. recurrent urinary tract infection. Seventeen (74%) recurrent urinary tract infection episodes were caused by pathogens different (phenotypically) from those isolated in 1st episode. Recurrent urinary tract infection occurred in 25.0%, 8.3%, and 0 patients recommended trimethoprim/sulfamethoxazole, cefuroxime-axetil, or amoxicillin prophylaxis, respectively. Conclusions (1) The study determined the incidence of urinary tract infection in febrile infants <2 months of age in Southern Israel; (2) E. coli was responsible for the majority of first and recurrent urinary tract infection; (3) recurrent urinary tract infection was caused mostly by pathogens different than the pathogens isolated at initial episode.
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Affiliation(s)
- Evgenia Gurevich
- Pediatric Department "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Pediatric Nephrology Clinics, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Dov Tchernin
- Pediatric Department "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Ruth Schreyber
- Pediatric Department "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Pediatric Nephrology Clinics, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Robert Muller
- Pediatric Nephrology Department, IVth Pediatric Clinic, University Children Hospital "St. Mary", G.T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Eugene Leibovitz
- Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
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Heckler AM, Sung J, Watters S, Martinez Acevedo A, Conlin M, Skoog S. The long-term incidence of urinary tract infection after endoscopic management of vesicoureteral reflux. Urology 2014; 83:1383-7. [PMID: 24685059 DOI: 10.1016/j.urology.2013.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/17/2013] [Accepted: 12/26/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the long-term urinary tract infection (UTI) rates after endoscopic correction of vesicoureteral reflux and the possible risk factors for urinary infection. MATERIALS AND METHODS A retrospective study of patients who underwent endoscopic management of vesicoureteral reflux at a single institution from 2001 to 2011 was performed. Patients were followed up for a minimum of 1 year. Voiding cystourethrograms were completed 3 months postoperatively. UTI questionnaire pertaining to the patient's UTI history before and after the surgery was mailed to each patient. Data were first evaluated looking only at culture-confirmed UTIs, and a second analysis included all patient-reported and culture-confirmed urinary infections. Factors considered in the analysis included sex, age, preoperative dimercaptosuccinic acid (DMSA) scan, reflux on postoperative voiding cystourethrogram, voiding dysfunction, and preoperative reflux grade. RESULTS Data on 175 patients for a minimum of 1 year were collected. There were 34 of 175 confirmed UTIs after endoscopic management, and 11 confirmed febrile UTIs. There were no significant predictors of febrile or afebrile UTIs in this group. Fifty-three of 175 patients (30%) experienced any UTI, 19 of which were febrile (10%). In this group, recurrent reflux was the only significant predictor of UTI (P=.03) and febrile UTIs (P=.04). Patients with more UTIs preoperatively were more likely to have a postoperative febrile UTI. CONCLUSION Rates of UTI and febrile UTI in endoscopic management are similar and no better than those for open ureteral reimplantation. Longer follow-up suggests an association of recurrent reflux and preoperative UTI rates as predictors of postoperative febrile UTIs. These patients benefit from closer postoperative observation.
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Affiliation(s)
| | | | - Sean Watters
- Oregon Health & Science University, Portland, OR
| | | | | | - Steven Skoog
- Oregon Health & Science University, Portland, OR.
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Govender N, Andronikou S, Goodier MDM. Adequacy of paediatric renal tract ultrasound requests and reports in a general radiology department. Pediatr Radiol 2012; 42:188-95. [PMID: 21997513 DOI: 10.1007/s00247-011-2259-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/04/2011] [Accepted: 06/26/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND According to current guidelines, US is the most important modality for imaging urinary tract infections (UTI) in children. OBJECTIVES (1) To assess the adequacy of paediatric renal US requests and reports in a general radiology department, and correlate the request adequacy and the performing radiologist's experience with report adequacy. (2) To determine the yield of abnormal findings. MATERIALS AND METHODS Retrospective review of renal US requests. The information was scored: requests 0-3 (3 as highest adequacy) and reports 0-21 (21 as highest adequacy). Correlation tests used included Spearman's correlation, Kruskal-Wallis test, Chi-square test of independence and Fisher exact test. RESULTS Mean report adequacy score was 6.67/21. Trainees did 87% of all scans and performed better (score 6.76) than the staff radiologists (score 6.08). Hydronephrosis was the most common abnormality. There was no correlation between request or reporter rank and reporting adequacy. CONCLUSION Renal US requests and reports are inadequate. To improve reporting standards for trainees and specialists, a renal ultrasound reporting template was designed for use.
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Affiliation(s)
- N Govender
- Radiology Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Al-Sayyad AJ, El-Morshedy SM, Al Hamid EAA, Karam NA, Imam ABA, Karam RA. Evaluation of Biomarkers to Differentiate Upper From Lower Urinary Tract Infections in Children. UROTODAY INTERNATIONAL JOURNAL 2011; 04. [DOI: 10.3834/uij.1944-5784.2011.08.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Doré-Bergeron MJ, Gauthier M, Chevalier I, McManus B, Tapiero B, Lebrun S. Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics 2009; 124:16-22. [PMID: 19564278 DOI: 10.1542/peds.2008-2583] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to examine the feasibility of outpatient management for 1- to 3-month-old infants with febrile urinary tract infections. METHODS A cohort study was performed with all children 30 to 90 days of age who were evaluated for presumed febrile urinary tract infections in the emergency department of a tertiary-care pediatric hospital between January 1, 2005, and September 30, 2007. Patients were treated with intravenously administered antibiotics as outpatients in a day treatment center unless they met exclusion criteria, in which case they were hospitalized. RESULTS Of 118 infants included in the study, 67 (56.8%) were admitted to the day treatment center and 51 (43.2%) were hospitalized. The median age of day treatment center patients was 66 days (range: 33-85 days). The diagnosis of urinary tract infection was confirmed for 86.6% of patients treated in the day treatment center. Escherichia coli was identified in 84.5% of urine cultures; 98.3% of isolates were sensitive to gentamicin. Six blood cultures (10.3%) yielded positive results, 5 of them for E coli. Treatment with intravenously administered antibiotics in the day treatment center lasted a mean of 2.7 days. The mean number of visits, including appointments for voiding cystourethrography, was 2.9 visits. The rate of parental compliance with day treatment center visits was 98.3%. Intravenous access problems were seen in 8.6% of cases. Successful treatment in the day treatment center (defined as attendance at all visits, normalization of temperature within 48 hours, negative control urine and blood culture results, if cultures were performed, and absence of hospitalization from the day treatment center) was obtained for 86.2% of patients with confirmed urinary tract infections. CONCLUSIONS Ambulatory treatment of infants 30 to 90 days of age with febrile urinary tract infections by using short-term, intravenous antibiotic therapy at a day treatment center is feasible.
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Affiliation(s)
- Marie-Joëlle Doré-Bergeron
- Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
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Kistner M. Dysfunctional elimination behaviors and associated complications in school-age children. J Sch Nurs 2009; 25:108-16. [PMID: 19233931 DOI: 10.1177/1059840509331442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lack of privacy, risk of bullying, limited access, lack of essential products for good hygiene, and dirty bathrooms can all contribute to encouraging a child to withhold urine and stool while in school. Withholding behaviors over time can create a condition known as dysfunctional elimination syndrome (DES). DES is any pattern of voiding or stooling that varies from the developmental norm. These abnormal patterns of elimination can eventually lead to complications of urinary tract infection, vesicoureteral reflux, and incontinence of urine and/or stool. School officials (teachers, school nurses, and school administrators) can help in the prevention of learned behaviors that lead to DES in school-age children. School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule. In addition, school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate. School nurses can be a powerful force in protecting children's health by participating in research and developing evidence-based guidelines to improve bathroom access and conditions.
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Affiliation(s)
- Mary Kistner
- General Surgery Department at Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, Texas, USA
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Bacchetta J, Cochat P. Antibiothérapie de l’infection urinaire : orale ou parentérale ? Arch Pediatr 2008; 15:1375-7. [DOI: 10.1016/j.arcped.2008.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
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Urinary interleukin-6 is useful in distinguishing between upper and lower urinary tract infections. Pediatr Nephrol 2008; 23:429-33. [PMID: 18040727 DOI: 10.1007/s00467-007-0670-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 10/12/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
This study was designed to determine whether the measurement of interleukin (IL)-6 in urine is useful for distinguishing between acute pyelonephritis and lower urinary tract infection. This observational study was carried out at León Hospital (Spain) on 35 patients (ten boys) aged between 0 and 14 years with urinary tract infection. Urinary levels of IL-6 were determined with enzyme-linked immunosorbent assay (ELISA) at diagnosis and after recovery. Renal dimercaptosuccinate acid (DMSA) scan was performed on all patients to discard or confirm acute pyelonephritis. The mean urinary concentration [x +/- standard deviation (SD)] of IL-6 at diagnosis was 20.3 +/- 23.3 and 5.3 +/- 9.7 pg/ml in patients with acute pyelonephritis and lower urinary infection, respectively [95% confidence interval (CI): 2.6-27.4; p < 0.01]. Specificity for a value of IL-6 >15 pg/ml, was 94.1% (95% CI: 91.1-97.1). Positive predictive value for IL-6 >15 pg/ml was 87.5% (95% CI: 81.1-93.8). IL-6 was undetectable in the urine of both groups of patients at the time of recovery. Urinary levels of IL-6 are useful in differentiating between upper and lower urinary tract infection in children. In this clinical setting, a value >15 pg/ml is a strong indicator of acute pyelonephritis.
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