Fungal Infection in Children with Obstructing Genito-Urinary Tract Pathology: Successful Management with Genito-Urinary Tract Drainage and Antifungal Therapy

Abstract

Purpose Children with urinary tract pathology are susceptible to bacterial urinary infection; fungal infection, although rare, is reported to be increasing. We describe the presentation, management and outcome of children with fungal infection associated with genito-urinary tract pathologies. Material and Methods Microbiology records at Alder Hey Children's Hospital (January 2007 - August 2009) indentified all children with fungal urinary tract infection and associated obstructed genito-urinary pathology. Case-notes were examined retrospectively. Results Eight children (4 males), aged 2 months to 19 years (median 6.5m) were identified (Candida albicans in 7). Obstructing lesions included posterior urethral valves (3), pelviureteric junction obstruction (2), ureteric stone (1) and urogenital sinus (2). Six children presented with sepsis; fungal infection was identified at the time of urinary tract drainage via nephrostomy, urethral catheter, suprapubic catheter or vaginal drain. Infection was identified in 2 with indwelling catheters through infection screening (managed with catheter change +/- vesicostomy). Seven children received antimicrobials prior to identification of fungal infection (prophylaxis in 2, therapeutic in 5). Initial treatment was with liposomal amphotericin, followed by oral fluconazole (6 patients), according to sensitivity testing. Antifungals were well tolerated; duration of treatment ranged from 10d to 6 weeks (median 4w). Duration of drainage ranged from 6d to 6 weeks in 5 patients (median 6w) (ongoing drainage 3). Fungal infection cleared in all patients. Conclusions Fungal infection is not rare in children with obstructing urinary tract abnormalities. Prior antimicrobial treatment is common. Cases respond to selective drainage combined with antifungals. Definitive treatment of obstruction should be considered once infection is controlled.