Urinary Infections In Children Research Articles

Characterization of Transferrable Mechanisms of Quinolone Resistance (TMQR) among Quinolone-resistant Escherichia coli and Klebsiella pneumoniae causing Urinary Tract Infection in Nepalese Children

BackgroundTransferrable mechanisms of quinolone resistance (TMQR) can lead to fluoroquinolone non-susceptibility in addition to chromosomal mechanisms. Some evidence suggests that fluoroquinolone resistance is increasing among the pediatric population. We sought to determine the occurrence of TMQR genes among quinolone-resistant E. coli and K. pneumoniae causing urinary tract infections among Nepalese outpatient children (< 18 years) and identify molecular characteristics of TMQR-harboring isolates.MethodsWe performed antimicrobial susceptibility testing, phenotypic extended-spectrum β-lactamase (ESBL) and modified carbapenem inactivation method tests, and investigated the presence of six TMQR genes (qnrA, qnrB, qnrS, aac(6’)-Ib-cr, oqxAB, qepA), three ESBL genes (blaCTX−M, blaTEM, blaSHV), and five carbapenemase genes (blaNDM, blaOXA−48, blaKPC, blaIMP, blaVIM). The quinolone resistance-determining region (QRDR) of gyrA and parC were sequenced for 35 TMQR-positive isolates.ResultsA total of 74/147 (50.3%) isolates were TMQR positive by multiplex PCR [aac(6’)-Ib-cr in 48 (32.7%), qnrB in 23 (15.7%), qnrS in 18 (12.3%), qnrA in 1 (0.7%), and oqxAB in 1 (0.7%) isolate]. The median ciprofloxacin minimum inhibitory concentration of TMQR-positive isolates (64 µg/mL) was two-fold higher than those without TMQR (32 µg/mL) (p = 0.004). Ser-83→Leu and Asp-87→Asn in GyrA and Ser-80→Ile in ParC were the most common QRDR mutations (23 of 35). In addition, there was a statistically significant association between TMQR and two β-lactamase genes; blaCTX−M (p = 0.037) and blaTEM (p = 0.000).ConclusionThis study suggests a high prevalence of TMQR among the quinolone-resistant E. coli and K. pneumoniae isolates causing urinary tract infection in children in this area of Nepal and an association with the carriage of ESBL gene. This is a challenge for the management of urinary infections in children. Comprehensive prospective surveillance of antimicrobial resistance in these common pathogens will be necessary to devise strategies to mitigate the emergence of further resistance.

Childhood Body Mass Index (BMI) and the Risk of Infection: A Narrative Review

Context: Infectious diseases are still one of the main causes of morbidity and mortality in children, especially in developing countries. In various studies, the weight of children has been found to be influential in the risk of occurrence of these diseases or their severity, and sufficient information on this matter can be important in improving the management and prognosis of patients. This study aimed to determine the impact of being underweight or obese on the risk of infection in children Evidence Acquisition: The ISI Web of Sciences, Scopus, PubMed, and Google Scholar databases were reviewed for relevant articles published from 2010 to 2022. The keywords used included: Infections, body mass index, obesity, thinness, underweight, and child. Results: Studies show that underweight children are associated with an increased risk of various parasitic, viral, and bacterial infections or their severity. Being overweight and obese have received less attention, but they have been shown to be effective in some respiratory and urinary infections in children. Conclusions: According to obtained results, being underweight or obese has been linked to an increased risk of various parasitic, viral, and bacterial infections or their severity in children. Therefore, determining the weight of children, even in emergency cases, and considering it, along with other initial evaluations of children with infection, can be effective in improving the management and prognosis of these children.

DIAGNOSIS AND ANTIBIOTIC RESISTANCE OF ENTEROCOCCUS SPP. CAUSING URINARY TRACT INFECTIONS IN CHILDREN

Introduction: Among Gram-positive bacteria, enterococci are considered the most frequent pathogens in the case of urinary tract infections (UTIs) in children. It is known that enterococci have intrinsic resistance and acquired resistance is achieved by different mechanisms for: beta-lactams, aminoglycosides, quinolones, glycopeptides and linezolid. Objectives: The purpose of this review is to demonstrate that Enterococcus spp. is a frequent cause of urinary infections in children and to analyze antibiotic resistance. Materials and methods: The research was conducted using specific keywords such as “antibiotic resistance”, “children”, “UTI”, “Enterococcus spp.”, and “biofilm”, in specialty books, Google Scholar, PubMed, ScienceDirect and PubMed Central (PMC). Results: Antibiotic resistance of Enterococcus spp. is an issue in the choice of treatment for urinary tract infections. According to certain research, resistance to vancomycin has increased in some countries while decreasing in others. Another concerning problem is the observed gentamicin resistance, notably in Enterococcus faecium. Discussion: Virulence factors, particularly Esp, which is involved in biofilm formation, play a key role in the processes of antibiotic resistance development. The presence of vanA and vanB genes modifies the structure of the bacteria and leads to the emergence of antibiotic resistance. Enterococcal resistance to vancomycin (VRE) represents a major public health problem and is the main mechanism that occurs in nosocomial infections. Conclusions: Enterococcus spp. is one of the most prevalent etiological agents in urinary pathology and a common source of nosocomial infections. Because of the presence of virulence factors and genes, these bacteria can easily acquire resistance to specific antibiotics. Keywords: antibiotic resistance, children, UTI, Enterococcus spp., biofilm

Выбор антибактериального препарата при инфекциях мочевыделительной системы у детей

Инфекции мочевыделительной системы в детском возрасте занимают второе место по частоте обращений за первичной медицинской помощью. Escherichia coli — наибольший причинно-значимый возбудитель внебольничных форм инфекций мочевыделительной системы, которые, как правило, носят неосложненный характер и чаще диагностируются у девочек после трехмесячного возраста. Klebsiella pneumoniae превалирует при нозокомиальных формах инфекций мочевыводящих путей, характеризующихся осложненным течением и чаще диагностируемых у мальчиков до трехмесячного возраста. Одной из причин повторных эпизодов инфекций мочевыводящих путей является формирование антибиотикорезистентности за счет действия β-лактамаз микроорганизмов к наиболее часто используемым антибактериальным препаратам группы аминопенициллинов. В литературном обзоре обоснован выбор антибактериальной терапии инфекций мочевыделительной системы в детском возрасте с учетом клинической эффективности, безопасности и чувствительности основных уропатогенов. Обобщены результаты рандомизированных клинических исследований эффективности и безопасности использования цефалоспорина III поколения цефиксима у детей с инфекциями мочевыделительной системы. Особое внимание уделено сохранению бактериальной чувствительности на уровне свыше 90 % к действию цефиксима у Escherichia coli и Klebsiella pneumoniae и высокой комплаентности при возможности однократного ежедневного перорального применения в качестве самостоятельной терапии на амбулаторном этапе и потенциального перехода от парентерального использования цефалоспоринов III поколения к менее инвазивному — пероральному приему, особенно у детей.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ СПЕКТРА ВОЗБУДИТЕЛЕЙ МОЧЕВОЙ ИНФЕКЦИИ УДЕТЕЙ ИРКУТСКОЙ ОБЛАСТИ И ДИНАМИКА БАКТЕРИАЛЬНОЙ РЕЗИСТЕНТНОСТИ В 2002-2004 и 2014-2016 гг.

In the structure of diseases of the urinary system in children, microbial-inflammatory lesions of the kidneys and urinary&#x0D; tract are 70–80 %. The prevalence of infections of urinary system in children in the Russian Federation is on average&#x0D; 18–22 per 1000 children’s population.&#x0D; The aim of the study was to analyze the spectrum of infectious agents of urinary infection in children and to determine&#x0D; the dynamics of bacterial resistance.&#x0D; We analyzed 330 cases of urinary system infection in children aged from 2 months up to 18 years in two time peri-&#x0D; ods – 2002–2004 and 2014–2016 (n = 114 and n = 216, respectively). Patients of both periods were divided into three groups: the first one – cystitis, the second one – pyelonephritis and the third group – a combination of pyelonephritis&#x0D; and cystitis. An obligatory criterion for including the patient in the study was the presence of a pathogmonic combina-&#x0D; tion of leukocyturia and bacteriuria, 10 5 KOE/ml, for the infection of the urinary system.&#x0D; The main causative agent of urinary infection in children remains E. coli. An increase is marked in the specific gravity&#x0D; of E. coli, Enterococcus spp. and Klebsiella spp., Pr. vulgaris.&#x0D; The study revealed the growth of E. coli resistance to cephalosporins of II, III, IV generations; decreased resistance of&#x0D; Enterococcus spp. to ampicillin and gentamicin. In the study of the sensitivity of Klebsiella spp. an increase was detected&#x0D; in resistance to cephalosporins of the III generation.&#x0D; We identified the main pathogens of infections of the urinary system and determined bacterial resistance.

Infección Urinaria en Niños y Niñas internados: Características Clínicas y Microbiológicas

Infección Urinaria en Niños y Niñas internados: Características Clínicas y Microbiológicas

Urinary Infection in Children and boarding Girls: clinical features and Microbiological

Urinary Infection in Children and boarding Girls: clinical features and Microbiological

Urinary Infections in Children

Urinary tract infection (UTI) is a common infection in infants and children. During infancy, boys are more commonly affected than girls and thereafter, female preponderance is found. Presentation varies among different age groups. Clinical features in neonates and young infants are non-specific, manifest as septicemia where a high index of suspicion is needed. Older children typically present as simple or complicated UTI. Rapid diagnosis, institution of early treatment and further evaluation by imaging modalities are of utmost importance. The prevention of recurrent UTI and detection of congenital anomalies of kidney and urinary tract are major objectives in the management. Use of ultrasound is required to detect underlying congenital abnormalities, whereas voiding cystourethrogram and dimercaptosuccinic acid (DMSA) scan are useful in the diagnosis of obstructive uropathy and vesicoureteric reflux and renal scar, respectively. The children requiring surgical interventions are to be recognised early to prevent recurrent UTI. The treatment of vesicoureteric reflux by chemoprophylaxis in lower grades and surgical treatment in higher grades are important consideration in prevention of recurrent UTI. This is required to prevent renal parenchymal damage and scarring that can cause hypertension and progressive renal insufficiency in later life.

Etiology of urinary tract infection in scholar children

To prospectively assess the prevalence of vesicourethral dysfunction in children over 3 years old, comparing it with the occurrence rate for other potential factors that cause urinary infection in this age range. 36 girls and 9 boys were assessed, with mean age of 6.4 years, ranging from 3 to 13.9 years. These children were prospectively assessed regarding the presence of symptoms of lower urinary tract dysfunction. These data were compared with the retrospective assessment of other potential risk factors for urinary infection. Ultrasonography was performed in 28 children and voiding cystourethrogram was performed in 26 patients. Vesicourethral dysfunction was diagnosed in 39 (87%) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77%) had urinary incontinence, 12 (31%) pollakiuria and 3 (8%) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22%) girls and phimosis in 2 (22%) boys. Obstipation was diagnosed in 10 (22%) cases. Significant post-voiding residue was detected in 4 (13%) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19%) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4%) cases there was not an apparent cause for the infection. Vesicourethral dysfunction is a major cause of urinary infection in children with ages above 3 years old. In cases where voiding dysfunction in not present, other predisposing factors must be assessed. However, only 4% of the patients did not present an apparent urologic cause for the infection.

Infecção do trato urinário: em busca das evidências

OBJETIVO: no presente trabalho, visamos abordar o tema infecção do trato urinário à luz da evidência clínica atual. FONTE DE DADOS: realizamos revisão bibliográfica no período de 1996 a 2002, utilizando os bancos de dados Medline e Cochrane, por meio das seguintes palavras-chave: infecção urinária, criança, adolescente, diagnóstico, tratamento e refluxo vesicoureteral. Foram selecionados estudos de coorte e de qualidade, consensos, meta-análises, ensaios randomizados controlados e auditorias. SÍNTESE DOS DADOS: os artigos levantados foram selecionados com base em aspectos metodológicos, relevância e aplicabilidade clínica. Parte dos destaques dos artigos baseiam-se nos parâmetros propostos pela Academia Americana de Pediatria, em 1999, para o diagnóstico e tratamento da infecção urinária febril da criança entre dois meses e dois anos de idade. CONCLUSÃO: grande parte das diretrizes para diagnóstico e tratamento da infecção urinária na infância ainda está baseada em opiniões consensuais e dogmáticas. Trabalhos multicêntricos, randomizados, controlados, duplo-cegos para intervenções são necessários para melhoria da qualidade do diagnóstico e da condução da infecção urinária na infância.

Urinary tract infection: a search for evidence

To review urinary tract infection in children taking into consideration evidence-based medicine. search of Medline and Cochrane databases, comprising the period between 1996 and 2002, with the following key words: urinary infection, vesicoureteral reflux, children, adolescents, diagnosis and treatment. Cohort studies, quality assurance studies, consensus, meta-analysis studies, randomized controlled trials and audits were selected. The studies were selected according to their methodology, relevance and clinical applicability. Some studies were selected based on the parameters proposed by the American Academy of Pediatrics in 1999 for the diagnosis and treatment of urinary tract infection in children between two months and two years of age. Consensus statements on diagnosis and treatment of urinary infection in children and adolescents are still mostly opinion-based. Randomized multicentric controlled trials, with double-blind allocation are necessary to improve quality of diagnosis and management of pediatric urinary tract infection.

Perfil de resistencia a los antimicrobianos en agentes causantes de infección del tracto urinario en niños chilenos: Programa de vigilancia PRONARES

PRONARES (Programa Nacional de Vigilancia de Resistencia) is a national surveillance program for antimicrobial susceptibility, focused in different syndromes and among these, urinary tract infections. The work is done in a laboratory net that uses common protocols and whose data are centrally analyzed using the WHONET program. To analyze the pattern of antimicrobial susceptibility of agents causing urinary infections in children in the period 1997-1999. In the study period, 5,525 strains were analyzed. Of these, 2,307 came from pediatric patients (1,495 hospitalized and 803 ambulatory). The most common causative agent was E. coli in 74.2% of cases, followed by Klebsiella spp in 8.2% and other agents in a lower frequency. Of E. coli strains, 74% were resistant to ampicillin, 52% to clotrimoxazole and 30% to first generation cephalosporins. These strains were sensitive to second and third generation cephalosporins, aminoglycosides, ciprofloxacin and nitrofurantoin. Strains from nosocomial or community infections had similar antimicrobial susceptibility. Klebsiella spp had a high rate of antimicrobial resistance (over 40%), that was even higher among nosocomial strains. It was 90% susceptible to ciprofloxacin and 100% to imipenem. All centers from which strains came had a similar pattern of susceptibility, with the exception of a pediatric center that had significantly higher resistance levels. The current therapeutic recommendations for urinary tract infections in children caused by E coli, are still pertinent, but the use of first generation cephalosporins must be cautious. The treatment of Klebsiella spp requires an individual antibiogram.

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

The objective of this study was to evaluate the basis for diagnosis and assessment of children &lt;2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2‐y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long‐term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.

Urinary infection in children

The authors make a review of the physiopathologic aspects of urinary tract infection, as well as the special characteristics of this pathology in the pediatric age. They focus on the extraordinary vulnerability of the child's kidney to infection, renal scarring and its consequences. They also refer to the fundamental aspects of diagnosis, treatment and follow-up of urinary tract infection in children.

Urinary tract infections in children below two years of age: a quality assurance project in Sweden. The Swedish Pediatric Nephrology Association.

The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2-y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long-term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.

CONTROL OF UROPATOGENIC E. COLI BY LACTOBACILLUS FERMENTUM PRODUCER OF H2O2

Lactobacilli are part of the normal flora of the genitourinary tract. When present, they can competitively exclude uropathogenic microorganisms, being various the factors responsables of this inhibition: production of bacteriocins, acid, H2O2. As E. coli is one of the most frequent pathogens isolated from urinary infections in children and in pregnant women, the objective of this work is to study the H2O2 production by L. fermentum (isolated from the urogenital tract of mice) and its inhibitory effect against uropathogenic E. coli. L. fermentum produces a maximun of 8.6 nmols/min/106 cells at 3 hours culture, being stable up to 24 hours. In mixed cultures of lactobacilli and E. coli, the inhibition increases by addition of mieloperoxidase and halide.; at 4 hours, the pathogen decreases from 109 to 107 CFU/ml, while the lactobacilli is stable. The number of viable microorganisms was determined by the succesive dilution method, employing selective culture media. Our results reflect the importance of H2O2 produced by lactobacilli and the peroxidase present in the urogenital ecosystem as an inespecific defense mechanism and of bacteria antagonisms against the urinary infections producer pathogens.

Ureteral dilatation in children with febrile urinary tract infection or bacteriuria.

Little information is available on the relationship between urinary infection in children and infants, with or without vesicoureteral reflux, and dilatation of the urinary tract. The purpose of this study was to determine the effects of infection and reflux on the diameter of the ureter at excretory urography in children with acute, febrile urinary tract infections and in infants with bacteriuria found at screening. Standardized measurements of ureteral diameter were obtained for 79 children (2 months to 6 years old) with urinary tract infections and for 45 infants with bacteriuria. Patients with urinary tract obstruction or malformations were excluded. Seventy-one children with febrile urinary tract infection had ureteral visualization that allowed measurements. Ureteral diameter in this group was significantly wider than in a reference group, and 42 children (59%) had ureteral diameters that were more than 2 standard deviations above the normal mean. Ureteral diameter at excretory urography increased with increasing grades of reflux, but dilatation occurred also in the absence of reflux. Twenty-two of the 45 infants in the group with bacteriuria had sufficient ureteral visualization for measurements. The ureters in this group were wider than in the reference group, and eight infants had ureteral diameters that were more than 2 standard deviations above the normal mean. We conclude that ureteral dilatation is a common effect of acute urinary tract infection and bacteriuria in children.

BIR Bulletin

BIR BulletinPublished Online:29 May 2014https://doi.org/10.1259/0007-1285-59-707-B61SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutAbstractThe Spring Meeting of the Welsh Branch of the BIR was held at Prince Charles Hospital, Merthyr, on Saturday, June 4, 1986. Dr John Parker was the organiser and chairman of the meeting and the theme of the symposium was urinary infection in children. Abstracts of the lectures are given below. Previous article FiguresReferencesRelatedDetails Volume 59, Issue 707November 1986Pages: 1057-B66 © The British Institute of Radiology History Published onlineMay 29,2014 Metrics Download PDF

Nalidixic acid and trimethoprim/sulphamethoxazole as alternatives for short-term treatment of urinary infections

The efficacy of 3-day therapy with nalidixic acid in 16 children, and trimethoprim/sulphamethoxazole in 19 children, was studied prospectively in children with an acute infection of the lower urinary tract and compared with that of a conventional 10-day course with the same drugs. The immediate cure rate was 97% in the 3-day group and 90% in the 10-day group. During 3 months of follow-up there were altogether six re-infections in children given short-term treatment and six in the conventionally treated group. The results give further support for the suggestion that 3-day therapy is equivalent to 10-day treatment in uncomplicated urinary infections in children and that both nalidixic acid and trimethoprim/sulphamethoxazole are good alternatives in such an approach.

Urinary infections in children 1985.

Journal Article Urinary infections in children 1985 Get access J M Smellie, J M Smellie University College Hospital, London, UK Correspondence: J.M. Smellie, D.M., F.R.C.P., D.C.H., Paediatric Department, University College Hospital, Gower Street, London WCIE 6AU, UK. Search for other works by this author on: Oxford Academic Google Scholar I C S Normand I C S Normand University of Southampton and Southampton General Hospital, UK Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 61, Issue 720, October 1985, Pages 895–905, https://doi.org/10.1136/pgmj.61.720.895 Published: 01 October 1985