Renal Ultrasound Evaluation of Urinary Tract Infections in Children

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 871-878
Author(s):  
Candice E. Johnson ◽  
Baz P. DeBaz ◽  
Paul A. Shurin ◽  
Rose DeBartolomeo

Ultrasonography of the kidney may replace the intravenous pyelogram as the study of choice in identifying treatable abnormalities in children with urinary tract infection. In a series of 64 consecutive children with urinary tract infection in whom an intravenous pyelogram, renal ultrasound, and voiding cystogram were performed, only one treatable abnormality (calyceal dilation) was identified by intravenous pyelogram, and it was not detected by ultrasound. Eleven children showed vesicoureteral reflux on the cystogram. In an additional 43 children in whom intravenous pyelogram was done only if the ultrasound or cystogram were abnormal, there were five abnormal cystograms. Four treatable abnormalities were identified by ultrasound, and three were confirmed by the intravenous pyelogram. Ultrasound should replace the intravenous pyelogram in children with a normal cystogram because of its accuracy, safety, and high patient acceptance. We have also documented a significant volume increase with acute infection in one or both kidney(s) of those children having upper urinary tract infection. Fifteen of 18 children with upper urinary tract infection had volume increases of 30% on more in at least one kidney; whereas only four of 21 children with lower urinary tract infection had increases of greater than 30% (P < .005). Ultrasound volume measurements provide a new, noninvasive method for identifying the probable site of urinary tract infection.

PEDIATRICS ◽  
1969 ◽  
Vol 44 (5) ◽  
pp. 677-684
Author(s):  
Duncan E. Govan ◽  
John M. Palmer

To study the influence of successful ureterovesicoplasty on incidence of recurrent urinary infection, two groups of infected children were compared in this regard before and after urologic evaluation. Of 280 new pediatric urologic hospital admissions, 55.6% had urinary tract infections. Sixty-six of these 156 infected children had vesicoureteral reflux. Bacteriologic localization of infection site was performed in both children with and without reflux at the time of diagnostic cystoscopy. Both groups were specifically treated with short-term antibiotic therapy and empiric urethral dilation. Operative vesicoureteroplasty was carried out in 62 children with reflux, with an overall cure rate of 83.8%. Distal urethral stenosis was not a contributing factor in this population nor did urethral caliber relate to the incidence of reflux. Only 3 of 35 children without reflux were found to have bacteriologically proved upper urinary tract infection. Similarly, only 32% of these children without reflux had clinical histories suggestive of recurrent pyelonephritis. In the children with reflux undergoing bacteriologic localization while infected, no nonrefluxing ureters were found infected, and only one third of the refluxing ureters so studied had proved upper urinary tract infection. Historical evidence for clinical pyelonephritis was present in 79% of the population with reflux; but, after successful cure of reflux, only 7% of these children continued to have pyelonephritic episodes. The long-term incidence of recurrent urinary tract infection was virtually identical, however, in the children undergoing successful antireflux surgery and the children without reflux following ureteral dilation. This relationship indicates that reflux plays little role in the etiology of bacteriunia but has a profound influence on urinary tract infection morbidity in children.


Author(s):  
George G. Zhanel ◽  
Michael A. Zhanel ◽  
James A. Karlowsky

Oral fosfomycin is approved in Canada for the treatment of acute uncomplicated cystitis. Several studies have reported “off label” use of oral fosfomycin in the treatment of patients with complicated lower urinary tract infection (cLUTI). This review summarizes the available literature describing the use of oral fosfomycin in the treatment of patients with cLUTI. Collectively, these studies support the use of a regimen of 3 grams of oral fosfomycin administered once every 48 or 72 hours for a total of 3 doses for patients who have previously failed treatment with another agent, are infected with a multidrug-resistant (MDR) pathogen, or cannot tolerate first-line treatment due to intolerance or adverse effects. Additionally, a Phase 2/3 clinical trial, known as the ZEUS study, assessed the efficacy and safety of intravenous (IV) fosfomycin versus piperacillin-tazobactam in the treatment of patients with complicated upper urinary tract infection (cUUTI) or acute pyelonephritis (AP) including in patients with concomitant bacteremia. IV fosfomycin was reported to be noninferior to piperacillin-tazobactam in treating patients with cUUTI and AP; however, when outcomes were independently evaluated according to baseline diagnosis (i.e., cUUTI versus AP), IV fosfomycin was superior to piperacillin-tazobactam in the treatment of patients with cUUTI and demonstrated superior microbiological eradication rates, across all resistant phenotypes including extended-spectrum β-lactamase- (ESBL-) producing Escherichia coli and Klebsiella spp. and carbapenem-resistant (CRE), aminoglycoside-resistant, and MDR Gram-negative bacilli (primarily Enterobacterales). Based on the ZEUS study, IV fosfomycin dosed at 6 grams every 8 hours for 7 days (14 days in patients with concurrent bacteremia) appears to be a safe and effective therapeutic option in treating patients with upper urinary tract infections, particularly those with cUUTI caused by antimicrobial-resistant Enterobacterales.


Author(s):  
Afagh FAZELI ◽  
Parivash KORDBACHEH ◽  
Ali NAZARI ◽  
Roshanak DAIE GHAZVINI ◽  
Hossein MIRHENDI ◽  
...  

Background: Candiduria in hospitalized patients may represent contamination, colonization, or urinary tract infections. On the other hand, candidemia and upper urinary tract infection could be the complications of candiduria. The aim of this study was to determine candiduria in hospitalized patients and identify isolated Candida species by conventional and molecular methods. Methods: This cross-sectional study was conducted on hospitalized patients in Imam Khomeini and Mostafa Khomeini hospitals in Ilam, western Iran from Jan to Dec 2016. Urine samples of hospitalized patients were collected during a period of 4 months for diagnosis of candiduria. Primary identification was done by conventional methods. PCR profile was carried out using phenol-chloroform method and confirmed using restriction fragment length polymorphism (PCR-RFLP) technique by MspI restriction enzyme. Results: Candiduria was diagnosed in 18 (9.2%) cases from a total of 195 patients. Isolated yeasts were identified as C. albicans (n: 13), C. glabrata (n: 5), and C. parapsilosis (n: 1) in the one case both C. albicans and C. glabrata were isolated from a urine sample. Conclusion: Candida urinary tract infection is becoming increasingly common in hospitalized patients but, differentiation fungal colonization from infection and identification of etiologic agents for optimal treatment is necessary.  


2014 ◽  
Vol 100 (4) ◽  
pp. 341-347 ◽  
Author(s):  
Adamos Hadjipanayis ◽  
Zachi Grossman ◽  
Stefano del Torso ◽  
Diego van Esso ◽  
Hans Juergen Dornbusch ◽  
...  

ObjectiveTo describe current practice among European paediatricians regarding diagnosis and management of urinary tract infections in children aged 1–36 months and to compare these practices with recently published guidelines.DesignWeb-based large scale survey evaluating knowledge of, attitudes towards and the methods for diagnosing, treating and managing urinary tract infections in children.SettingPrimary and secondary care practices in Europe.Sample1129 paediatricians.ResultsA diagnosis of urinary tract infection is considered by 62% of the respondents in children aged 1–36 months with unexplained fever. The preferred method of urine collection is use of a bag (53% for infants <3 months and 59% for children 4–36 months of age). 60% of paediatricians agree that oral and parenteral antibiotics have equal efficacy. Co-amoxiclav is the antibiotic of choice for 41% of participants, while 9% prescribe amoxicillin. 80% of respondents prescribe ultrasound in all children with a confirmed urinary tract infection. 63% of respondents prescribe a cystography when abnormalities are revealed during ultrasound evaluation. A quarter of respondents recommend antibiotic prophylaxis for all children with any vesicoureteral reflux. The data among European countries are very heterogeneous. The three most recent urinary tract infection guidelines (the National Institute for Health and Care Excellence (NICE), the American Academy of Paediatrics and the Italian Society of Paediatric Nephrology) are not followed properly.ConclusionsManagement of febrile urinary tract infections remains controversial and heterogeneous in Europe. Simple, short, practical and easy-to-remember guidelines and educational strategies to ensure their implementation should be developed.


2018 ◽  
Vol 1 (3) ◽  
pp. 26-38
Author(s):  
Abdulghani Mohamed Alsamarai ◽  
Shler Ali Khorshed

Background: Urinary tract infection is common with health impact in women and characterised by failure to treatment and recurrent episodes. Aim: This study was conducted to determine the risk factors for the development of urinary tract infection in diabetic and pregnant women in comparison to student female. Materials and methods: A prospective cross-sectional study conducted during the period from 1st of June 2015 to the end of January 2016. The population included in the study are 563 women, of them 425 were outpatients, and 138 were inpatients. Their age range between 18 and 80 years, with a mean age of 33.59±15.29 years. Urine samples collected and cultured on blood agar and MacConkey agar by spread plate technique. Bacterial colonies with different morphology were selected, purified and identified according to their biochemical characteristics using conventional standard methods. Results: In diabetic women, there were no significant difference in mean age and BMI values between culture positive and culture negative groups. However, pus cell mean scale was significantly higher [P=0.000] in women with urinary tract infection [1.76±1.25] than in those with negative culture [0.69±1.00]. In pregnant women, BMI mean value was significantly [P=0.013] lower in pregnant women with UTI [26.14] as compared to those without infection [26.99]. Pus cell scale mean value was significantly [P=0.000] higher in pregnant women with UTI [1.55] than women with negative UTI [0.85]. While there was no significant difference in mean age between UTI positive and negative pregnant women. In female student, there was a significant difference between UTI infected and non-infected in mean age [P=0.041] and pus cell scale [P=0.000]. However, BMI was not significantly different between infected and non-infected female student. Other risk factors association are variables in the 3 groups when analysed using X2, while AUC and OR show different trends of association between risk factors and UTI. Conclusion: BMI, pus cell scale, child number, delivery method, operation history and hospital setting were significantly associated with culture positivity in the 3 studied groups as determined by AUC. While OR confirmed association with pus sale scale in the 3 groups.


Author(s):  
Rana M. Abdullah Al-Shwaikh ◽  
Abbas Falih Alornaaouti

       Current study obtained (75) isolate of Pseudomonas aeruginosa collected from different cases included : 28 isolates from otitis media, 23 isolates from burn infections, 10 isolates from wound infections, 8 isolates from urinary tract infections and 6 isolates from blood, during the period between 1/9/2014 to 1/11/2014        The result revealed that the tox A gene was present in 54 isolates (72%) of Pseudomonas aeruginosa. The gel electrophoresis showed that the molecular weight of tox A gene was 352 bp. The result shows 17 isolates (60.71%) from otitis media has tox A gene, 18 isolates (78.26%) from burn followed by 8 isolate (80%) from wound infection and 5 isolates (62.5%) from urinary tract infection , finally 6 isolates (100%) from blood have this gene.


2018 ◽  
pp. 100-108
Author(s):  
Dinh Khanh Le ◽  
Dinh Dam Le ◽  
Khoa Hung Nguyen ◽  
Xuan My Nguyen ◽  
Minh Nhat Vo ◽  
...  

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection


Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 997-1002
Author(s):  
Hao Wu ◽  
Rui Zheng

AbstractOrgan abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.


2017 ◽  
Vol 38 (8) ◽  
pp. 998-1001 ◽  
Author(s):  
Taniece Eure ◽  
Lisa L. LaPlace ◽  
Richard Melchreit ◽  
Meghan Maloney ◽  
Ruth Lynfield ◽  
...  

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001


Renal Failure ◽  
2008 ◽  
Vol 30 (4) ◽  
pp. 377-381 ◽  
Author(s):  
F. Catal ◽  
N. Bavbek ◽  
O. Bayrak ◽  
E. Uz ◽  
B. Isik ◽  
...  

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