Review Urinary Tract Infection in Pediatrics Patients
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This document discusses atypical and recurrent urinary tract infections. Atypical UTIs are serious illnesses characterized by poor urine flow, abdominal masses, elevated creatinine levels, sepsis, unusual infecting organisms, and failure to respond to antibiotics. Recurrent UTIs are defined as two or more episodes of upper UTIs, one upper and one or more lower UTIs, or three or more lower UTIs.
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Review Urinary Tract Infection in Pediatrics Patients
- 27. Atypical UTI: Serious illness, poor urine flow, abdominal or bladder mass; elevated creatinine, septicemia, infection with an organism other than E. coli , and failure to respond to antibiotics within 48 hours; Recurrent UTI: ≥2 episodes of upper UTI, one episode of upper UTI plus ≥1 episode of lower UTI, or ≥3 episodes of lower UTI
Editor's Notes
- The mucosal surface of the uncircumcised foreskin is more likely to bind uropathogenic bacterial species than keratinized skin on a circumcised penis [ 17 ]. The keratinization of the mucosa is largely complete by one year of age and temporally coincides with the decreasing prevalence of UTI in boys. Partial obstruction of the urethral meatus by a tight foreskin may be the explanation for the higher incidence of UTI in uncircumcised boys A systematic review of randomized and observational studies of circumcision for the prevention of UTI found that 111 circumcisions would be needed to prevent one UTI (
- In addition, women with recurrent UTI have a higher density of receptors for E. coli in the periurethral area. On the other hand, individuals with mutations in the toll-like receptor (TLR) signaling pathway do not mount a significant inflammatory response, even when virulent bacteria are present
- An uncentrifuged specimen A hemocytometer (results reported as WBC/mm 3 ) A Gram-stained smear Examination of a catheterized urine sample using these three techniques, which are available at some academic centers, has been called an "enhanced urinalysis" [ 24 ]. When using the enhanced urinalysis, pyuria is defined by ≥10 WBC/mm 3 and bacteriuria by the presence of any bacteria per 10 oil immersion fields of a Gram-stained smear.
- Supine and frog leg position เพื่อ pelvic stable Paint midline, approximately one to two centimeters above the pubic symphysis +/- ฉีดยาชา ปิด urethra opening เพราะหัตถการนี้จะกระตุ้น urination ในเด็ก 1.5 inch, 22-gauge needle attached to a 3 or 5 mL syringe แทง 1-2 cm เหนือ pubic symphisis ทำมุม 10-20 องศา ใส negative pressure
- Asymptomatic = colonization : ไม่เกิด renal sequale ตามมา พบได้ 1/3 , ไม่ recommend ให้ใช้ antibiotics
- In a randomized, controlled trial of 306 children 1 to 24 months of age with a febrile UTI, oral therapy with cefixime for 14 days was as effective as intravenous therapy with cefotaxime for three days followed by oral therapy with cefixime In a systematic review, short course antimicrobial therapy (2-4days) was as effective as standard duration (7 -14 days) therapy in eradicating bacteria in children with suspected lower urinary tract infection (ie, afebrile children) we recommend a longer course of therapy for febrile children (usually 10 days) and a short course of therapy (three to five days) แต่ยังไม่มีการศึกษาชัดเจนถึงระยะเวลาการให้ใน febrile UTI
- The revised AAP practice guideline does not recommend prophylactic antimicrobials following the first febrile UTI in children 2 to 24 months [ 3 ]. Pending results of the RIVUR study, we agree with this recommendation. However, if a voiding cystourethrogram (VCUG) is performed and demonstrates grade III or higher VUR, we suggest antimicrobial prophylaxis (NICE) guideline for UTI in children indicates that antibiotic prophylaxis should not be routinely recommended in infants and children following their first UTI, but may be warranted after recurrent UTI
- ถ้า clinical แย่ ทำได้เลยใน acute setting แต่ถ้า ตอบสนองดีต่อยาให้ทำหลังจากนั้น
- Focal cortical thickening, depression of cortex, hyperechoic band เหนือ thinning parenchymal
- Although there is little supportive evidence for the timing of follow-up for reflux for patients on medical therapy, evaluation is recommended every 12 to 18 months
- Mandatory urine cultures and urinalysis are required whenever there are urinary symptoms suggestive of UTI or unexplained fever Renal ultrasonography can be used to monitor renal growth and detect the presence of gross scarring. In our practice, renal ultrasounds are routinely performed annually in patients who are medically treated. The AUA guidelines suggest that selective monitoring for renal scarring by DMSA renal scan is advised for patients at risk for significant abnormalities that may affect their care [ DMSA renal scans are also obtained in patients with break-through infections, abnormal renal function, or an abnormal renal ultrasound. In our practice, we screen siblings and children of patients with VUR because of the increased familial incidence of VUR. Our approach, which is consistent with the AUA guidelines, is to selectively screen younger siblings with a renal and bladder ultrasound (RBUS) [ 15 ]. A VCUG is only performed in patients with an abnormal ultrasound (eg, renal cortical abnormalities or asymmetry) or if there is a history of UTI.