Urinary Tract Infection In Children Research Articles

Decreasing the Use of Cefdinir for Pediatric Urinary Tract Infections in a Rural Health Care System: A Quasi-experimental Study.

There are several antimicrobial options for treating urinary tract infection in children. Although cefdinir is commonly used, better options exist. We developed an intervention bundle to reduce the use of cefdinir in favor of cephalexin. The intervention bundle decreased cefdinir use by 19.1% while use of cephalexin increased by 19.8%.

Assessment of Urinary Tract Infection and Estimation of Procalcitonin Serum Level Among Iraqi Children

Urinary tract infections (UTIs) considered as a serious public health issue, especially in children, which can be caused by a variety of organisms, especially gram-negative bacteria. Procalcitonin (PCT) is a precursor of the calcitonin hormone, which normally released in the thyroid gland, and this biomarker has become more effective in diagnosing bacterial infections in the last decade. Moreover, to establish the utility of procalcitonin for predicting urinary tract infections in children. The current study included two groups of patients of approximately sixty cases from patients with urinary tract infection (UTI), besides, sixty cases from healthy individuals. Samples were collected from Al Imamain Al-Kadhimain Medical City in Baghdad. The result showed a highly significant difference in procalcitonin levels in UTI patients compared to the control group. The results of this investigation support the use of PCT as an indicator for the diagnosis of UTI children.

Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Diagnosing Urinary Tract Infections in Children: A Systematic Review and Meta-Analysis.

This study presents a comprehensive review of the literature regarding the use of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic tool for urinary tract infection (UTI) in children. Meta-analysis was conducted to evaluate the effectiveness of uNGAL in diagnosing UTI and differentiating acute pyelonephritis (APN) from other sites infection in pediatric patients. We searched PubMed, Web of Science, the Cochrane Library and EMBASE for reports published up to January 2023. We only included published literature that addressed the diagnosis of UTI and APN with the use of uNGAL in children aged 0-18 years. Two authors independently reviewed the included studies and extracted the corresponding data according to the inclusion and exclusion criteria. The sensitivity, specificity and area under the curve for each study were pooled by using a bivariate mixed-effects model. A total of 13 studies met the inclusion criteria for this review: 8 reported on uNGAL diagnosis of UTI, 2 on uNGAL diagnosis of APN, and 3 on both UTI and APN. Among all included studies, uNGAL had good sensitivity (0.88, 95% CI 0.79-0.94) and good specificity (0.86, 95% CI 0.78-0.92) for the diagnosis of UTI. The sensitivity and specificity of uNGAL for the diagnosis of APN were 0.79 (95% CI 0.72-0.85) and 0.78 (95% CI 0.50-0.93), respectively. uNGAL has good sensitivity and specificity in the diagnosis of UTI in children and is a promising marker. However, the use of uNGAL still does not provide significant advantages in the diagnosis of APN in children. Consequently, there is a need to optimize and further explore the assay for improved diagnostic accuracy.

Antibiotic Appropriateness for Urinary Tract Infections in Children.

We examined local prescribing patterns across the entire treatment course for children treated for uncomplicated urinary tract infection (UTI) to determine opportunities for antibiotic stewardship initiatives. We conducted a retrospective review of emergency department and inpatient encounters for febrile and afebrile UTI in a children's hospital from 2021 to 2022. An antibiotic spectrum ranking was established, and providers' choices were assessed for appropriateness on the basis of the individuals' urine culture (UCx). Groups were stratified by fever presence and compared using χ2, Fisher's exact, and Mann-Whitney U tests. Of 172 encounters (83% emergency department), 99 (58%) had a positive UCx. Eighty (80%) grew Escherichia coli, with 67 (84%) being susceptible to cefazolin (minimum inhibitory concentration ≤16 mg/L). There were 229 antibiotic regimens and 39 (17%) were appropriate. Inappropriate antibiotic choices included unnecessary use of broad-spectrum antibiotics and misdiagnosed UTI. Grouping by encounter, at least 1 dose of a third cephalosporin was given in 51% of encounters, and 80% of these received it unnecessarily because of UTI misdiagnosis or suitability of a narrower-spectrum antibiotic. The median prescribed antibiotic duration was 7 days (interquartile range 7-10). Of 73 encounters with UCx growing mixed flora or a nonuropathogen, only 29 (40%) had antibiotics discontinued. Confirmed UTI was associated with fever and nitrite positivity. Our study revealed high prevalence of inappropriate antibiotics, particularly unnecessary prescribing of third cephalosporin, prescriptions not supported by laboratory data, and prolonged treatment courses. Our results identify factors that can be used to support UTI treatment pathways and ensure antibiotic stewardship.

A-260 Mapping pediatric urinary tract infections: trends, prevalence and sensitivity to antimicrobials

Abstract Background Urinary tract infections (UTIs) rank among the most prevalent bacterial infections in pediatric populations, with neonates being particularly susceptible. Moreover, UTIs have a propensity for recurrence, posing ongoing health challenges. Prompt diagnosis of pediatric UTIs is crucial for timely and effective treatment, averting potential long-term complications. While clinical signs often suggest UTI diagnosis, additional tests like urinalysis and urine culture are vital to identify the causative pathogen and its antibiotic sensitivity. This study aims to quantify microorganism prevalence in positive pediatric urine tests and assess their antimicrobial resistance profiles. The purpose is, therefore, to offer scientific basis so that there is greater agility in establishing the diagnosis of UTIs in children and indicating the best antibiotic to be used empirically to prevent late consequences. Methods Between January and December 2019, a cross-sectional study was carried out with urine samples from children and adolescents collected in the database of the Clinical Analysis Laboratory of Cuiabá - MT in 2019. Only records of samples collected in the study were included in the study. laboratory of patients of both sexes, age range 1 month to 15 years. Bacterial analyzes were classified according to Gram positive, Gram negative (glucose fermenters or non-fermenters) and the sensitivity profile was standardized according to the Clinical and Laboratory Standards Institute (2019). The data were subjected to descriptive statistical analysis. Results Of the 532 positive urine samples from pediatric patients, enterobacteria were responsible for 435 (81.76%) with E. coli (64.1%) and Proteus mirabilis (15.8%) being the most isolated bacteria, in relation to Gram-positive bacteria 64 (12.03%) main bacteria was Enterococcus faecalis (81.2%) and non-glucose fermenters for 33 (6.2%) corresponding to Pseudomonas aeruginosa. E. coli, with 279 cases, was the most frequently isolated microorganism, representing (64.1%) of the cases. Females were the most affected, in 83.5% there was growth of Enterobacteria, in the Pseudomonas aeruginosa group, 51.5% of cases were female. and in Gram+ girls represented 56.2%. In those tested only for E. coli, the highest sensitivity was observed in fosfomycin (97.82%). Enterobacteriaceae showed high susceptibility to meropenem (99.8%), ertapenem (99.8%), ceftriaxone (93.8%), and ceftazidime (93.6%), but exhibited considerable resistance to sulfamethoxazole/trimethoprim (35.5%), amoxicillin (33.4%) and ampicillin (29.2%). Pseudomonas aeruginosa and gram positive bacteria were sensitive to all antibiotics tested. Conclusions The data indicate that E. coli continues to be the predominant agent in pediatric UTIs, particularly affecting females and the very young age group < 3 years. Regarding sensitivity profiles, bacteria were more sensitive to carbapenems and aminoglycosides. Early diagnosis is crucial to preventing long-term complications associated with UTIs in children. Consequently, this research provides a scientific basis for faster UTI diagnosis and empirical antibiotic selection in pediatrics, which may prevent late adverse outcomes.

Upper tract dilation is an independent risk factor for febrile UTI in children with primary vesicoureteral reflux

BackgroundChildren with vesicoureteral reflux (VUR), particularly high-grade VUR, are known to be at increased risk for urinary tract infection (UTI). Current guidelines highlight certain clinical factors in the management of children with VUR; however, the clinical utility of upper tract dilation in the setting of VUR remains unclear. ObjectiveThe purpose of this study is to evaluate risk factors for febrile UTI (fUTI) in children with primary VUR in a modern cohort with emphasis on upper tract dilation parameters, including hydronephrosis and hydroureter. MethodsA prospectively maintained database of children with VUR at a single academic institution from July 2013 to February 2023 was reviewed. Demographic and clinical data were included. Ultrasounds closest to initial VCUG were reviewed for upper tract dilation, including the presence of hydronephrosis, Society of Fetal Urology (SFU) hydronephrosis grade, presence of hydroureter, and anterior-posterior renal pelvic diameter (APRPD). The primary outcome of interest was the development of a fUTI after VUR diagnosis. Patients were censored after their first fUTI or after VUR surgery. ResultsA total of 235 children with primary VUR were evaluated, including 125 (53.2%) females and 110 (46.8%) males. The median age of VUR diagnosis was 10.8 months (IQR: 2.3-63.6 months). A total of 41 (17.4%) children developed a fUTI after VUR diagnosis with a median follow up of 2.3 years (IQR: 0.9-4.6 years). On univariate analysis, variables found to be associated with fUTI included age < 1 year at VUR diagnosis (p=0.021), female sex (p=0.013), high-grade VUR (p=0.024), APRPD ≥ 7 mm (p=0.007), high-grade hydronephrosis (p=0.004), presence of hydronephrosis (p=0.029), and hydroureter (p=0.008). In children with VUR and high-grade hydronephrosis, a larger APRPD was associated with higher fUTI rates (p=0.008). On multivariate analysis controlling for age, sex, and VUR grade, APRPD ≥ 7 mm (OR 2.8, p=0.009), high-grade hydronephrosis (OR 2.5, p=0.025), and presence of hydronephrosis (OR 2.3, p=0.049) were independent risk factors for fUTI. On multivariate models controlling for other upper tract dilation parameters, APRPD ≥ 7 mm was the most significant parameter associated with increased fUTI risk in primary VUR. ConclusionUpper tract dilation is a novel, independent risk factor for fUTI in children with primary VUR, with APRPD being the strongest predictor. Clinicians may consider upper tract dilation parameters in addition to age, sex, and VUR grade when individualizing care in children with primary VUR.

Short- versus standard-course antibiotic therapy for urinary tract infection in children: a systematic review and meta-analysis.

Urinary tract infections are prevalent among children and are responsible for a significant healthcare burden. Antibiotic therapy is the cornerstone of treatment, but the optimal treatment duration remains elusive. This systematic review and meta-analysis aimed to explore the optimal duration of antibiotic therapy for urinary tract infection (UTI) in pediatric patients. A comprehensive search was performed, including MEDLINE, Embase, and Cochrane Library databases. We included only randomized controlled trials (RCTs) comparing short-course (2 to 5days) and standard-course (≥ 7days) antibiotic treatment in patients < 18years of age. We performed this systematic review and meta-analysis following Cochrane Collaboration recommendations using a random-effects model. Effect estimate was calculated using the risk ratio (RR) with 95% confidence interval (95% CI) for dichotomous and mean difference (MD) with 95% CI for continuous endpoints. Significance was regarded at p-value < 0.05. Statistical analysis was performed using Review Manager 5.4.1. Data from 12 RCTs, encompassing 1442 children, were included. Follow-up ranged from 1 to 12months. The mean age was 5.9years, with approximately 87% female patients. E. coli was the most common pathogen isolated from urine cultures. There was a significant difference in cure rates (RR 0.97; 95% CI 0.95-0.99; p = 0.01) between the groups when only studies that included febrile UTI were analyzed together, favoring 7days or more of treatment, but with high heterogeneity. Otherwise, there was no significant difference in cure rates (RR 0.99; 95% CI 0.91-1.08; p = 0.80) in children with afebrile UTI or recurrence of UTI at any time in children with afebrile (RR 0.98; 95% CI 0.84-1.15; p = 0.80) or febrile UTI (RR 0.52; 95% CI 0.10-2.83; p = 0.45). Also, there was no significant difference in failure rates in children with urinary tract abnormalities and afebrile UTI (RR 0.79; 95% CI 0.47-1.32; p = 0.36), between the short- and the standard-course treatment groups. This analysis was limited by the moderate heterogeneity and the small subgroup of children with urinary tract abnormalities, which could have underpowered our results. The primary outcome of this analysis suggests that a short course of antibiotic therapy is feasible in children with afebrile UTI, but more studies are warranted to safely establish an optimal treatment duration for children with febrile UTI. The study protocol was registered in the PROSPERO platform under the number CRD42023489094.

Molecular detection of Pseudomonas aeruginosa isolated from children with urinary tract infections

The purpose of this research was to identify Pseudomonas aeruginosa from pediatric UTI samples using molecular methods. Bacteria were isolated and identified using a primary medium. Children from all around Baghdad city who were hospitalized at a private clinic between 2019 to 2022 and showed symptoms of a urinary tract infection (UTI) such as fever and vomiting, had their urine sampled. There were 132 samples of children's urine collected from kids who had UTIs. The VITEK-2 system was completed on pure bacterial isolates. DNA of these bacteria was done and two primers were used in this study for the detection of P. aeruginosa. The present study showed that the rate of infection by P. aeruginosa was 7.6%, the total Gram-positive bacteria were 22.7% and the total Gram-negative bacteria were 77.3%. It was shown that females had a greater rate of UTI (55.3% vs. 44.7%) than males. In conclusion, because of its prevalence and severity in community-acquired UTIs in children and its unique risk factors and outcomes, P. aeruginosa should be suspected in any child who has recently received or is now receiving antibiotic treatment.

Testing for nephrological diseases in pediatrics – the role of point-of-care devices and the medical analysis laboratory in the current context

Background and objectives. Nephrological diseases in children are common, representing an important burden on patients and healthcare. The purpose of this study is to evaluate the transition of the most recent advances in the in vitro diagnostics (IVD) field, including point-of-care (POC) testing methods, to the clinical practice in pediatrics. Materials and methods. Testing indications for pediatric nephrological diseases were identified in the available clinical guidelines and, for comparison, the developments in the IVD field were reviewed based on scientific literature about testing methods, performance evaluation, and POC testing implementation. Results. Testing in the context of nephrological diseases is widely addressed in the available clinical guidelines. While performant POC tests have been developed, the recommendations for testing do not address this progress, nor their integration with traditional laboratory tests. For example, urine dipstick testing has a central role in the management of urinary tract infections of children and it is a basis for clinical decisions, the same method being available for both POC and laboratory tests. Conclusions. Specific testing recommendations for nephrological conditions must be elaborated, based on the availability of the methods and their performances. Implementing POC testing is a challenge, but it can provide benefits for both the patient and the healthcare systems, in addition to the standard laboratory testing.

Do Vitamin D Levels Play a Role in Urinary Tract Infection in Children?

Previous studies have shown the protective effects of vitamin D supplementation against urinary tract infection (UTI). However, there are a few contradictory studies on the negative effect of vitamin D supplementation on UTI. Our objective was to establish whether there existed a relationship between serum vitamin D levels and UTIs in children. This study compared the serum 25-hydroxy vitamin D [25(OH)D] levels of children diagnosed with UTIs with those of healthy children (control group). We found a high rate of 25(OH)D deficiency in both the control and case groups (90% and 66.7%, respectively). Therefore, we added the laboratory parameters calcium, phosphate, and parathormone (PTH) to our analysis. We assessed the medical records of 60 patients diagnosed with UTIs and 20 healthy controls. The mean serum 25(OH)D level and PTH level were significantly higher in the patient group than in the control group. The PTH level was significantly lower in the acute pyelonephritis (APN) group than in the control group (p=0.016). Phosphate levels in the APN group were significantly lower than those in the control and cystitis groups (p=0.04, p=0.006 respectively). Because there was no correlation between 25(OH)D level and UTI, we concluded that 25(OH)D had no effect on UTI.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED). We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022. We assessed the various urine WBC thresholds associated with culture-proven UTIs using sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and area under receiver operating characteristic curve. We found a culture-proven UTI rate of 460/1188 (38.7%) among all patients analysed, and 278/998 (27.9%) among those with nitrite-negative urine samples. Among all patients, a urinalysis WBC threshold of 100/μL had a sensitivity of 82.2% (95% confidence interval [CI] 78.4-85.5) and negative predictive value of 86.2% (95% CI 83.6-88.4). Among those who were nitrite-negative, a WBC threshold of ≥100/μL resulted in a potential missed rate of 48/278 (17.3%). By lowering the WBC threshold to ≥10/μL, the potential missed cases reduced to 6/278 (2.2%), with an estimated increase in 419 urine cultures annually. A urine microscopy WBC threshold of ≥100/μL results in a clinically significant number of missed UTIs. Implementation of various thresholds should consider both the potential missed UTI rate and the required resource utilisation.

Relationship between urinary tract infections and serum vitamin D level in adults and children- a literature review.

Over time, researchers have accumulated significant evidence indicating that vitamin D deficiency not only impacts skeletal health but also contributes to the development and progression of various diseases, including cancer, diabetes, and cardiovascular conditions. The risk of low serum 1, 25(OH)2D3 level ultimately directs the way to morbidity, the beginning of new diseases, and numerous infections. Infections are the first entity that affects those with vitamin D deficiency. The common infection is urinary tract infection(UTI), and its relationship with vitamin D deficiency or insufficiency remains controversial. This infection affects both men and women, but comparatively, women are more prone to this infection because of the short length of the urethra, which makes an easy entry for the bacteria. The low level of serum vitamin D increases the risk of UTIs in children. Recurrent UTIs are one of the major weaknesses in women; if left untreated, they progress to appallingly serious conditions like kidney dysfunction, liver damage, etc. Hence improving the vitamin D status may help to improve the immune system, thus making it more resistant to infections. In this review, we have focused on examining whether vitamin D deficiency and insufficiency are the causes of UTIs and the association between them in women and children. We have also described the connection between vitamin D deficiency and insufficiency with UTIs and additional nanotechnology- based treatment strategies.

Investigating the interaction of zno nanoparticles with flagellum and fimbriae in multi-drug resistant uropathogenic bacteria encoding fli and fim genes.

Due to the increasing occurrence of drug resistant urinary tract infections (UTI) among children, there is a need to investigate alternative effective treatment protocols such as nanoparticles. Flagella and fimbriae are primary factors contributing the virulence of urinary tract infecting bacteria. The aim of this study was to assess the antibacterial effects of zinc oxide nanoparticles which have been synthesized using both chemical and green methods on multi-drug resistant (MDR) uropathogenic bacteria encoding fli and fim genes and investigating their binding ability to bacterial appendage proteins. A total of 30 urine culture samples were collected from children under 2 years old diagnosed with urinary tract infection. The isolates underwent antibiotic suseptibility assessment and the isolates demonstrating MDR were subjected to molecular amplification of fimG (fimbrial) and fliD and fliT (flagellal) genes. The confirmation of cellular appendages was achieved through silver nitrate staining. The antibacterial efficacy of the synthetized nanoparticles was assessed using the micro and macrodilution methods. The successful binding of nanoparticles to bacterial appendage proteins was confirmed through mobility shift and membrane filter assays. The dimensions of chemically synthesized ZnO nanoparticles and green nanoparticles were measured at 30nm and 85nm, respectively, with the exhibition of hexagonal geometries. The nanoparticles synthesized through chemical and green methods exhibited minimum inhibitory concentrations (MIC) of 0.0062-0.025g/L and 0.3g/L, respectively. The ability of ZnO nanoparticles to bind bacterial appendage proteins and to combat MDR uropathogenic bacteria are promising for new treatment protocols against UTI in children in future.

Risk factors in children with recurrent urinary tract infection among patients attending Al Zahra Teaching Hospital in Iraq

Abstract Urinary tract infections (UTI) are considered one of the most common infections that occur in the pediatric age group, leading to very serious morbidity and mortality. The detection of risk factors for urinary tract infection helps in the management and prevention of the recurrence of the infection. This study attempts to review current information on UTIs and determine different risk factors in association. To study the risk factors that are associated with recurrent urinary tract infection in different age groups of childhood among children attending AL Zahra Teaching Hospital. A case-control study was conducted in AL Zahra Teaching Hospital during the period from October 1st, 2021, to July 30th, 2022. It included 76 children with highly suggestive histories, their examination, and results of the investigations (e.g. urine cultures), as well as 150 healthy children who were taken as controls. The controls were without a history of recurrent UTI and were similar to patients in age, sex and other risk factors that were mentioned in the study. A completed questionnaire was given to each child’s mother, and then the results were analyzed. The study showed that non educated mothers OR (3.2), vesicouetrerall reflux OR (3), uncircumcised male OR (2.94), female gender OR (2.7), age groups below than 6 years OR (2.4), low social class OR (2.1) and residency in rural area (OR 2.5) contributed to UTI issues. When compared to control groups, non educated mothers and vesicoureteral reflux were highly significant risk factors, and other risk factors such as female gender, uncircumcised male, age less than 6 years, low social class and rural area were significant for febrile recurrent urinary tract infection in children.

Frequency of Bacteria Causing Urinary Tract Infection and Their Antibiotic Resistance Among Children

Background: Childhood urinary tract infections (UTIs) are among the most prevalent diseases. In recent years, the overuse of common antibiotics has increased antibiotic resistance among urinary tract pathogens worldwide, with changes in the pattern of microbial resistance varying by geographical area and time. Objectives: This study aims to investigate the pattern of microbial resistance of UTI pathogens in pediatric patients. Methods: In this cross-sectional study, children aged &lt; 13 years with UTI and positive urine cultures, who were admitted to Bahrami Hospital in Tehran, Iran, between 2015 and 2019, were evaluated. The pathogens' frequency, their antimicrobial resistance, and clinical and demographic information were extracted from the patients' files. Statistical relationships between clinical and demographic data and antibiotic resistance were analyzed using appropriate statistical tests. Results: The files of 202 patients were evaluated. The majority of patients were female (79.2%). UTI was more common among the 12 - 60 months age group (36.3%) in females and the 1 - 12 months age group (50%) in males. The most common UTI pathogen was Escherichia coli (85.1%). The lowest rates of microbial resistance were related to Meropenem (0% resistance), Gentamicin (9.2%), and Amikacin (10.8%). Conversely, the highest resistance rates were observed for Cotrimoxazole (74.6%), Ampicillin (74.5%), and Cephalothin (64.9%). Conclusions: UTI is more common in females aged 1 to 60 months. E. coli is the most common cause of UTI. Microbial resistance to antibiotics used for empirical treatment, such as ceftriaxone, is high and changes over time. It is recommended to use alternative antibiotics and avoid the inappropriate administration of antibiotics.

Acute Focal Bacterial Nephritis without Pyuria: A Peculiar Subtype of Urinary Tract Infection.

Acute focal bacterial nephritis (AFBN) without pyuria is a subtype of urinary tract infection in children, often leading to diagnostic challenges. The clinical characteristics of 6 children diagnosed with AFBN, who exhibited an absence of pyuria, were retrospectively summarized and compared with the control group consisting of 49 hospitalized AFBN children with pyuria. The cases of AFBN without pyuria presented with more severe inflammatory responses and were predisposed to complications, such as sepsis and neurological abnormalities.

The Sensitivity Pattern of Uropathogens towards Oral Antibiotics among Children with Urinary Tract Infection

Background: Urinary tract infection (UTI) is common in paediatric age group. Because of extensive and injudicious use of oral antibiotics, uropathogens show increasing resistance to these drugs. The objective of the study was to identify the susceptibility pattern of uropathogens towards oral antibiotics among children suffering from UTI who were admitted to the paediatric ward at Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet. Materials and methods: This cross-sectional study was carried out among 100 children aged 2 months to 12 years, who had a confirmed diagnosis of UTI based on urine culture reports and was admitted to the paediatric department of Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet. The study period was 1st January 2018 to 31st December 2019. Results: The mean age of the patients was 46.48±38.58 months. Males were 34% and females were 66% and the male-female ratio was 1:1.9. The common presenting complaints of UTI cases were fever (67%), dysuria or crying during micturition (53%), abdominal pain (42%), an increased frequency of micturition (30%), and nausea and vomiting (26%). The most common isolated organism was E. coli (61%), followed by Klebsiella species (31%). Nitrofurantoin was the drug that the isolated organisms were most sensitive to, followed by levofloxacin and ciprofloxacin. The isolated organisms were highly resistant to cephalexin, amoxicillin, cephradine, cefaclor, cefixime, azithromycin, and co-trimoxazole. Conclusion: Uropathogens are mostly sensitive to nitrofurantoin, levofloxacin, and ciprofloxacin. These drugs may be used to empirically treat UTI in children, if necessary. Judicial antibiotic use should be practised to prevent the development of antibiotic resistance.

First episode of febrile urinary tractinfection in children, detection and risk factors of kidney scarring: Aprospective cohort study.

This prospective study aimed to evaluate the characteristics and findings of children who presented with acute pyelonephritis (APN) and to determine the independent risk factors for kidney scarring. Patients who satisfied the following criteria were enrolled in the study: first known episode of APN; at least two of the following findings: fever ≥ 38.5 °C, white blood cell count ≥ 10,000/mm3, erythrocyte sedimentation rate ≥ 20 mm/h, C-reactive protein ≥ 20 mg/dL; absence of congenital abnormalities or other kidney and systemic diseases, except vesicoureteral reflux (VUR); no APN relapses until the time of kidney scar detection. 99mTc-Dimercaptosuccinic acid kidney scintigraphy (99mTc-DMSA) was performed at admission, along with a kidney ultrasound. Follow-up 99mTc-DMSA took place after 6 months. Radiographic cystourethrography for VUR detection and grading was performed 1 month after the acute infection. We enrolled 70 children in the study. The kidney ultrasound failed to diagnose more than half of the cases of APN. VUR was found in 21.5% of children. 75% had findings of APN in the acute phase through 99mTc-DMSA, while in the second 99mTc-DMSA, there was a complete remission in 68% of them. Scars were observed more frequently in older children, children with VUR grade ≥ III, and children not on antibiotic prophylaxis. VUR did not appear to be associated with the first episode of APN, and children older than 1 year of age had a higher risk of scarring. Antibiotic prophylaxis may prevent kidney scarring due to host immunomodulatory effects, but more studies are needed so that conclusions can be drawn.

Risk Factors for Urinary Tract Infection in Children

Background &amp; objective: Urinary tract infections (UTIs) are a common cause of febrile illness in young children. Due to the absence of overt clinical features in young children, appropriate collection of urine samples, and basic diagnostic tests at first-level health facilities in our country, UTIs are not generally reported as a cause of childhood morbidity. Due to a lack of studies on the epidemiology, risk factors, diagnosis, treatment, prognosis, and prevention of UTI in children in our country, the exact picture of this disease is yet unknown. This study is intended to identify the risk factors of UTI in children in our country. Methods: The present cross-sectional study was carried out in the Department of Pediatrics (both indoor and outdoor) of Bangabandhu Sheikh Mujib Medical University, BIRDEM, and Dhaka Medical College Hospital over a period of 1½ years from January 2015 to June 2016. A total of 201 children with signs and symptoms suspected of having urinary tract infections were subjected to urine culture; of them, 98 had definitive UTI and the rest 103 had no UTI or possible UTI. Several factors such as circumcisional status, constipation, encopresis, previous hospital admission, and premature birth were investigated whether they had any role in contributing to the development of UTI. Result: The children with UTIs were relatively young compared to those without UTIs. However, the age incidence of UTI was found to differ by sex. About one-third of UTI cases in boys were found in the first year of life, one-third between 2nd to 3rd year of life, and the rest one-third in 3rd year onwards. However, the peak age incidence in girls was observed to be 3rd year and onwards. In terms of clinical presentation, fever, and anorexia were more or less common (52% and 43.7% respectively), abdominal pain was less common (18%), and irritability and vomiting were seldom observed. The presence of constipation was significantly associated with UTI in children (p = 0.001). Encopresis was considerably higher in the UTI group than in the non-UTI group (p = 0.169). Conclusion: Children with UTI usually present with fever with or without dysuria, frequency, anorexia, and abdominal or loin pain. While boys more often acquire the disease in their infancy, girls usually present with the problem from 3 years during their toilet training. Thus, the children presented with unexplained febrile illness or any other signs and symptoms should be suggested for a urine culture to find the clue of febrile illness. Identification of risk factors of UTI will go a long way in preventing the same illness in the future. Ibrahim Card Med J 2023; 13 (1&amp;2): 60-65

Characteristics of urinary tract infections in children with positive urine culture for Aerococcusurinae

Urinary tract infections caused by Aerococcus urinae have rarely been reported in children, and the clinical characteristics remain unclear. We reviewed medical records of children whose urine cultures grew A. urinae (≥104 CFU/mL) at a tertiary children's hospital in Tokyo, Japan. We found 17 pediatric patients in a review of 22,769 urine cultures between June 2006 and May 2022. The median age of 17 patients was 10.7 years (IQR 8–13 years), and males represented 76.5 % of the patients. Sixteen patients (94.1 %) had underlying urological conditions (neurogenic bladder, vesicoureteral reflux, urethral stenosis, bladder exstrophy, or urinary catheterization). The chief symptoms were fever (35.3 %), malodorous urine (23.5 %), nausea (11.8 %), and back pain (5.9 %). Ten patients were asymptomatic. Pyelonephritis was diagnosed in five male patients. All of them had underlying abnormal conditions of the bladder, and two had malodorous urine. All patients had favorable outcomes after 10–14 days of ampicillin/amoxicillin-based antimicrobial therapy.