Urinary Tract Infection In Children Research Articles

Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children

BackgroundThe aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece.MethodsThe UTIs-specific quality indicators were informed by a review of the existing literature. Quality indicators were selected to describe the overall antibiotics use, prescribing patterns and UTIs clinical management regarding treatment and prophylaxis in a cohort of children admitted with a UTI. Microbiological, clinical and prescribing data about dosing, duration and route of administration were collected from the patients’ electronic health records.ResultsTwelve quality indicators were adapted or developed for prescribing in childhood UTIs. A broad variety of antibiotics were prescribed for UTIs, with a drug utilization (DU) 90% rate of 6 and 9 different antibiotics for febrile and afebrile UTIs, respectively. Despite the low incidence of multi-drug resistant UTIs in the study period (9/261, 3.4%), broad-spectrum antibiotics were prescribed in 33.5% (164/490) of prescriptions. A total of 62.8% (164/261) of patients were started on empiric combined therapies, while opportunities to de-escalate were missed in 37.8% (62/164) of them. One quarter (67/261, 25.7%) of patients did not fulfil the criteria for receiving treatment, while nearly half of those prescribed prophylaxis (82/175, 46.9%) could have avoided having a prophylaxis prescription.ConclusionsOur study identified substantial gaps for improvement in antimicrobial prescribing for UTIs in children. The application of the proposed quality indicators could help to limit unnecessary antibiotics use in children with UTI.

The Association between Serum Vitamin D Levels and Urinary Tract Infection Risk in Children: A Systematic Review and Meta-Analysis.

The association between serum vitamin D levels and urinary tract infection (UTI) in children is unclear. We undertook a systematic review and meta-analysis to evaluate the relationships between different vitamin D levels and the likelihood of UTI in children. Online databases, including Web of Science, PubMed, Embase, and Cochrane Library, were searched up to 6 February 2023 for studies based on the inclusion criteria. Weighted mean difference (WMD) and Odds Ratios (ORs), along with their 95% confidence intervals (CI), were calculated, and the random-effects model was used for analysis. Twelve case-control studies and one cross-sectional study (839 children with UTI and 929 controls) were included. We found that children with UTI had lower levels of serum vitamin D than healthy controls (WMD: -7.730, 95% CI: -11.57, -3.89; p < 0.001). Low vitamin D levels were significantly associated with UTI in children (OR: 2.80; 95% CI: 1.55, 5.05; p = 0.001). The likelihood of children having a UTI significantly increased when their serum vitamin D level was less than 20 ng/mL (OR: 5.49, 95% CI: 1.12, 27.04; p = 0.036). Therefore, vitamin D level, especially when less than 20 ng/mL, is a risk factor in UTI.

Bacterial Pathogens and Antimicrobial Susceptibility Patterns of Urinary Tract Infections in Children during COVID-19 2019-2020: A Large Tertiary Care Center in Saudi Arabia.

One of the most prevalent bacterial infections in children is urinary tract infection (UTI), which has become a major concern with increasing resistance of the pathogens to the routinely used antimicrobial agents. The aim of the study is to determine the antimicrobial susceptibility patterns of pediatric UTI-causing pathogens, including ESBL-producing bacteria, in Saudi Arabia. This cross-sectional retrospective study was conducted to ascertain the frequency of isolation and the antimicrobial resistance pattern of uropathogens among children aged 0-15 years. The data from the urine cultures was collected during 2019-2020 at the King Fahad Medical City, a major tertiary hospital in Riyadh, Saudi Arabia. A total of 1022 urine samples from patients diagnosed with urinary tract infections (UTIs) were collected for this study. Microbial species present in the samples were cultured and identified using standard biochemical techniques. To assess the resistance of these strains to antimicrobial drugs, an in vitro method was employed, and the criteria set by the Clinical Laboratory Standard Institute (CLSI) were followed. In addition, a double-disc synergy test was conducted to identify strains of E. coli that produce extended-spectrum beta-lactamase (ESBL). The predominant pathogens were E. coli (58.6%), followed by Klebsiella sp. (23.9%). E. coli isolates were more sensitive to meropenem and ertapenem in 99.2% of cases, followed by amikacin (99%). Klebsiella sp. were sensitive to amikacin in 97.1% of cases, followed by meropenem and ertapenem (92.2% in both). The highest sensitivities of antimicrobials toward ESBL were for meropenem and ertapenem (100% in both), followed by amikacin (99%). Our study recommends using local antibiotic sensitivity data for empirical UTI treatment. Amikacin, ertapenem, and meropenem are effective intravenous options. Cephalosporin, cefuroxime, amoxicillin/clavulanic acid, and nitrofurantoin are suitable oral choices. No significant changes in antimicrobial susceptibility were observed during the COVID-19 pandemic. Further research is needed to assess potential pandemic-related alterations.

Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

Controversy exists on the clinical utility of kidney ultrasonography after first febrile urinary tract infection (UTI), and clinical practice guideline recommendations vary. To determine the prevalence of urinary tract abnormalities detected on kidney ultrasonography after the first febrile UTI in children. The MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched for articles published from January 1, 2000, to September 20, 2022. Studies of children with first febrile UTI reporting kidney ultrasonography findings. Two reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics and outcomes were extracted from each article. Data on the prevalence of kidney ultrasonography abnormalities were pooled using a random-effects model. The primary outcome was prevalence of urinary tract abnormalities and clinically important abnormalities (those that changed clinical management) detected on kidney ultrasonography. Secondary outcomes included the urinary tract abnormalities detected, surgical intervention, health care utilization, and parent-reported outcomes. Twenty-nine studies were included, with a total of 9170 children. Of the 27 studies that reported participant sex, the median percentage of males was 60% (range, 11%-80%). The prevalence of abnormalities detected on renal ultrasonography was 22.1% (95% CI, 16.8-27.9; I2 = 98%; 29 studies, all ages) and 21.9% (95% CI, 14.7-30.1; I2 = 98%; 15 studies, age <24 months). The prevalence of clinically important abnormalities was 3.1% (95% CI, 0.3-8.1; I2 = 96%; 8 studies, all ages) and 4.5% (95% CI, 0.5-12.0; I2 = 97%; 5 studies, age <24 months). Study recruitment bias was associated with a higher prevalence of abnormalities. The most common findings detected were hydronephrosis, pelviectasis, and dilated ureter. Urinary tract obstruction was identified in 0.4% (95% CI, 0.1-0.8; I2 = 59%; 12 studies), and surgical intervention occurred in 1.4% (95% CI, 0.5-2.7; I2 = 85%; 13 studies). One study reported health care utilization. No study reported parent-reported outcomes. Results suggest that 1 in 4 to 5 children with first febrile UTI will have a urinary tract abnormality detected on kidney ultrasonography and 1 in 32 will have an abnormality that changes clinical management. Given the considerable study heterogeneity and lack of comprehensive outcome measurement, well-designed prospective longitudinal studies are needed to fully evaluate the clinical utility of kidney ultrasonography after first febrile UTI.

A multicentre, retrospective audit of fosfomycin use for urinary tract infections in Australian children and adolescents.

Urinary tract infections (UTIs) due to MDR organisms are increasingly common. The lack of paediatric data on efficacious antibiotics makes UTI treatment particularly challenging. Data on the efficacy of fosfomycin use for UTI in children are variable. We conducted a retrospective audit of children aged 0-18 years who were treated with fosfomycin for UTI at seven tertiary paediatric hospitals in Australia over a 7 year period, from 2014 to 2020. Ninety-one children with a median age of 5 years (range 2 months to 18 years) received oral fosfomycin for UTI. The majority (57/91, 63%) had one or more comorbidity, with the most common being renal tract anomalies (24/91, 26%). Fifty-nine (65%) had febrile UTI, 14/91 (15%) had pyelonephritis and 1/91 (1%) was bacteraemic. A majority (80/91, 88%) of urinary cultures had an ESBL-producing Gram-negative pathogen isolated. Fosfomycin susceptibility was evident in all 80 isolates tested. For uncomplicated UTI, the most common dose in children aged <1, 1-12 and >12 years was 1, 2 and 3 g, respectively. For complicated UTI, doses of 2 and 3 g were most common. The median duration of fosfomycin administration was 5 days (range 1-82). Clinical cure was achieved in 84/90 (93%); the six with treatment failure had underlying comorbidities. Overall, 2/91 (2%) children experienced drug-related adverse effects comprising gastrointestinal symptoms in both, which resolved after treatment discontinuation. Fosfomycin is well tolerated and associated with favourable treatment outcomes in children with UTI. Further research on the optimal dosing strategy is required.

Biomarkers for febrile urinary tract infection in children.

The current reference standard for pediatric urinary tract infection (UTI) screening, the leukocyte esterase (LE) dipstick test, has suboptimal accuracy. The objective of this study was to compare the accuracy of novel urinary biomarkers to that of the LE test. We prospectively enrolled febrile children who were evaluated for UTI based on their presenting symptoms. We compared the accuracy of urinary biomarkers to that of the test. We included 374 children (50 with UTI, 324 without UTI, ages 1-35 months) and examined 35 urinary biomarkers. The urinary biomarkers that best discriminated between febrile children with and without UTI were urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-1β, CXCL1, and IL-8. Of all examined urinary biomarkers, the urinary NGAL had the highest accuracy with a sensitivity of 90% (CI: 82-98) and a specificity of 96% (CI: 93-98). Because the sensitivity of the urinary NGAL test is slightly higher than that of the LE test, it can potentially reduce missed UTI cases. Limitations of using urinary NGAL over LE include increased cost and complexity. Further investigation is warranted to determine the cost-effectiveness of urinary NGAL as a screening test for UTI.

Frequency of urinary tract infection in children with nephrotic syndrome.

Objective: To Determine the Frequency of Urinary Tract Infection in Children Presenting With Nephrotic Syndrome. Study Design: Descriptive Cross Sectional Study. Setting: Department of Pediatrics, Lady Reading Hospital (LRH), Peshawar. Period: 16th July 2019 to 15th July 2020. Material &amp; Methods: All children presenting with nephrotic syndrome were evaluated, detailed history was obtained and complete detailed examination were performed to exclude the confounders and possible bias in the results of this study. From all these children, mid-stream clean urine catch urine was obtained with strict sterile technique and the sample was to hospital laboratory to diagnose UTI. Data was analyzed by SPSS. Results: Of these 106 study cases, 69 (65.1%) were male patients while 37 (34.9%) were female patients. The mean age of this study population was 7.71±3.11 years. Mean Duration of Illness was 5.25±4.38 months and 52.8% had duration of illness up to 6 months. Of these 106 study cases, 70 (66.00%) mothers were illiterate and 36(34.00%) mothers were literate. Urinary Tract Infection (UTI) was diagnosed in 27 (25.5%). Conclusion: Our Study results concludes that the frequency of urinary tract infection is very high (25.5%) in children with Nephrotic syndrome.

Extended-Spectrum β-Lactamase-Producing Escherichia coli and Virulence Genes in Pediatric Patients with Health-Care Urinary Tract Infections.

Healthcare-associated urinary tract infection (UTI) represents a significant health problem, especially in infants and young children. The most common pathogen associated with this infection is Escherichia coli (E. coli). The present study aimed to detect the frequency of virulence genes among clinical isolates of E. coli isolated from healthcare-associated urinary tract infections in children and the correlation between these virulence genes and the presence of the blaCTX gene. The study included one hundred clinical isolates of E. coli isolated from healthcareassociated urinary tract infections in children in intensive care units. The isolates were subjected to antibiotics sensitivity by disc diffusion method and detection of extended-spectrum beta-lactamase by double disc diffusion method. In addition, multiplex polymerase chain reaction (PCR) was used to detect some virulence genes, and PCR was used to detect the blaCTX-M gene. E. coli producing ESBL by double discs method was identified in 74 isolates. blaCTX-M gene detection by PCR was identified among 38 isolates representing 51.4% of ESBL-producing E. coli. There was a significant association between ESBL and blaCTX-M Gene, P = 0.0001. The frequency of the studied virulence genes by multiplex PCR in the isolated E. coli was 66% for the Fim gene, 75% for the Aer gene, 68% for the FliC gene, 53% for each of IucD gene and Usp gene, 40% for pap gene, 35% for each of AFA and ironN genes and 17% for sfa gene. None of the isolated E. coli had the Cdt gene. There was a significant association between the presence of the FimH gene (P = 0.0001), Pap gene (P = 0.05), sfa (P = 0.026), Afa gene (P = 0.018), and aer gene (P = 0.035) and the presence of the blaCTX-M gene in the isolated E. coli. The present study highlights the presence of virulence genes and blaCTX-M gene in uropathogenic E. coli isolated from pediatric patients with healthcare-associated urinary tract infections. There was an association between the blaCTX-M gene and virulence genes FimH, pap, sfa, Afa, and aer. Various distributions of the studied genes with a high frequency of fimbria are flic genes. Moreover, the ESBL had high frequency in E. coli with the presence of blaCTX-M in about one-third of the isolates.

Imaging investigation after urinary tract infection in childhood: narrative review of current recommendations

Imaging investigation after urinary tract infection in childhood: narrative review of current recommendations

Antimicrobial Sensitivity Pattern of Causative Agents of Urinary Tract Infection in Children Between 1 to 15 Years

Background: The presence of actively multiplying organisms in the urinary tract implies urinary tract infection. Although it is infrequently associated with mortality, it is still an important cause of morbidity in the pediatric age group. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with urinary tract infection. The objective of the study was to find out the causative agents of urinary tract infections and their antibiotic sensitivity pattern in pediatric patients.&#x0D; Methods: This was a cross-sectional study conducted in the department of pediatrics over a period of 12 months and 80 patients fulfilled the inclusion criteria. The modes of presentation, laboratory investigation reports which included urine routine microscopy, bacterial isolates with colony count from the urine culture, and antibiotic sensitivity pattern were documented. Descriptive statistics were used for analysis of data.&#x0D; Result: Escherichia coli was the most common organism isolated (55.9%). Most of them were sensitive to amikacin.The highest degree of resistance was noticed with ampicillin.&#x0D; Conclusion: Aminoglycosides like amikacin can be considered as first-line drugs in urinary tract infection. &#x0D; Keywords: antibiotics, children, urinary tract infections.

Do We Have Enough Evidence to Lower the Urinary Bacterial Colony Counts for the Diagnosis of Urinary Tract Infection in Children?

Do We Have Enough Evidence to Lower the Urinary Bacterial Colony Counts for the Diagnosis of Urinary Tract Infection in Children?

Urinary Tract Infection in Children Presenting with Nephrotic Syndrome

Background: Nephrotic syndrome, or nephrosis, is defined by the1presence of nephrotic-range1 proteinuria, edema, hypoalbuminemia &amp; hyperlipidemia. Nephrotic syndrome remains the common manifestation of glomerular disease in childhood. UTI is a common infection accompanying nephrotic syndrome. But there is no local evidence available. Aim: To assess the frequency of urinary tract infection in children presenting with nephrotic syndrome in a tertiary1care hospital. Study design: Cross sectional study. Methodology: Total 280 children fulfilled the inclusion criteria were included through non-probability convenience sampling. Urine sample was obtained in sterile container &amp; was sent to the pathology1laboratory of the hospital. Then reports were assessed &amp; if pathogen was present, then UTI was labeled. Data was evaluated by using SPSS v.24. Quantitative data was presented as mean±SD. Qualitative data was presented as frequency and percentage. Chi-square test was applied with P-value ≤0.05 taken as significant. Results: The mean age was 7.07±3.09years. There were 152(54.3%) males and 128(45.7%) females. The mean weight of patients was 24.30±7.75kg. The mean duration of nephrotic syndrome was 9.66±5.37months. There were 147(52.5%) patients who had UTI while 133(47.5%) patients did not have UTI. Practical Implication: As there is a high incidence of UTI among nephritic children and there is lack of local data that specifically addresses this health issue thus current study was planned. Results regarding precise estimate of UTI frequency in nephrotic syndrome patients helped to formulate recommendations for early screening to initiate early management of UTI. This information also helped in reducing morbidity and mortality in children with nephrotic syndrome. Conclusion: It was concluded that frequency of UTI was high in children with nephrotic syndrome hence screening of UTI is necessary on regular intervals in children with1nephrotic syndrome. Keywords: Urinary Tract Infection, Nephrotic Syndrome, Children, Proteinuria and Albuminuria.

ПАТОЛОГИЯ МОЧЕВЫДЕЛИТЕЛЬНОЙ СИСТЕМЫ И ЕЕ ЧАСТОТА У ДЕТЕЙ НА ФОНЕ COVID-19

This review presents data on endothelial dysfunction and the mechanisms of its development in coro-navirus disease. The possible pathology of the urinary system and its frequency in children against the background of COVID-19, which is mainly due to endothelial dysfunction, is described. Displayed studies on the frequency of urinary tract infections in children and adolescents during a pandemic, which depended on the level of quarantine measures, which in turn affect the neuro-psychological causes of bladder dysfunction, limited timely access to medical care, etc. A systematic review of stud-ies published in English from 2000 to 2019 was performed (with predominant inclusion (84,6 %) of data for the last 2 years) using PubMed, ScienceDirect, ProQuest, GoogleScholar, Cochrane, Medline, AMED databases., EMBASE, CINHAL, SportDiscus, Scopus and PEDro. The review included review articles, meta-analyses, qualitative studies, retrospective and prospective studies.

Urinary Tract Infection in Children

Infeksi saluran kemih merupakan infeksi yang sering ditemukan pada anak-anak, dimana infeksi dapat mengenai bagian atas maupun bawah dari traktus urinarius. Infeksi saluran kemih merupakan salah satu penyebab demam tersering yang dialami oleh anak-anak, terutama anak perempuan. Infeksi saluran kemih digolongkan ke dalam infeksi saluran kemih atas (pielonefritis), saluran bawah (sistitis) dan bakteriuria asimtomatik. Penelitian ini bertujuan mengeksplorasi gejala, diagnosis dan penatalaksanaan infeksi saluran kemih pada anak. Ditemukan bahwa dalam menegakkan diagnosis infeksi saluran kemih, dibutuhkan analisis urin dan pemeriksaan kultur urin, dengan memperhatikan pengambilan sampel urin. Pemeriksaan urinalisis dapat digunakan untuk menegakkan diagnosis dari infeksi saluran kemih jika ditemukan adanya leukosit esterase atau nitrit yang positif dan kultur urine. Penatalaksanaan infeksi saluran kemih pada anak dapat menjadi tantangan karena gejala yang muncul secara samar dan tidak spesifik, namun penatalaksanaan infeksi saluran kemih harus memperhatikan tingkat resistensi, usia anak, lokasi infeksi saluran kemih, tingkat keparahan, dan antibiotik yang diberikan, sedangkan pengobatan terhadap infeksi saluran kemih dilakukan untuk mencegah terjadinya sepsis pada anak, dimana penggunaan antibiotik masih merupakan salah satu terapi utama untuk mengatasi infeksi saluran kemih pada anak. Penggunaan antibiotik pada anak dengan Vesicoureteral Reflux (VUR) bertujuan untuk mengurangi kekambuhan infeksi saluran kemih, sehingga direkomendasikan antimikroba dengan dosis yang rendah.

Mayer‐Rokitansky‐Küster‐Hauser syndrome presented as recurrent urinary tract infection in childhood (case report)

AbstractBackgroundMayer‐Rokitansky‐Küster‐Hauser syndrome (MRKH) is characterized by the absence of the uterus and upper two‐thirds of the vagina, normal secondary sexual development, and 46XX karyotype is one of the rare types of Mullerian agenesis. There may be associated congenital anomalies in other organ systems especially those with the same embryogenesis such as the urinary tract mostly in its upper parts present in 40% of cases including renal agenesis, ectopic kidney (unilateral or bilateral), renal hypoplasia, horseshoe kidneys, and hydronephrosis. Other organ systems also may be affected such as skeletal and auditory systems. MRKH is diagnosed mostly during or after adolescence because of unexpected amenorrhea or disturbed sexual experiences.Case reportWe present a 3‐year‐old girl coming with recurrent bouts of urinary tract infections diagnosed as having MRKH syndrome established by imaging and genetic studies. Our case is very rare and interesting because it presents itself as a recurrent urinary tract infection in early childhood which is rare and unusual. In this case, early detection helped us to prevent chronic kidney disease and also planning to perform necessary minimal but very important surgical procedures before initiation of sexual activities to relieve the psychosocial aspect of the syndrome both for the child and parents.ConclusionHealth givers should keep in mind that rare syndromes may present as a repeated quite common problem or have confusing or conceiving presentations. This point will assist us in the early detection of rare diseases at an earlier age or stage.

Accelerated bacteriological examination of urine and dialysate in the diagnosis of urinary tract infections in children

Aim. To evaluate the feasibility of an accelerated method for determining the etiology of infections in urine, dialysate and residual antimicrobial activity by using laser light scattering technology.Materials and methods. From January to September 2019, 106 urine samples and 42 dialysate samples from children aged 1–16 with various urinary pathologies and those on peritoneal dialysis underwent culture-based examination on an ALIFAX HB&amp;L LIGHT analyzer (Alifax, Italy) using laser light scattering technology.Results. Three hours after inoculation, 81 samples (76.4%) appeared to be negative and 25 samples (23.6%) proved to be positive. No microorganisms were detected in 38 dialysate samples (90.5%), two samples had Staphylococcus aureus (104 CFU/ml), and one dialysate sample had Corynebacterium sp. and associations of Escherichia coli + Candida albicans + Staphylococcus haemolyticus, associated with peritoneal catheter colonization. Bacteriuria was caused by Enterobacterales in 39.3% (E. coli, Morganella morganii, Citrobacter amalonaticus, Enterobacter cloacae), non-fermenting gram-negative bacteria – in 14.3% (Pseudomonas aeruginosa, Ralstonia picketii, Oligella sp., Acinetobacter baumannii), Enterococcus sp. – 21.4%, S. haemolyticus, Staphylococcus epidermidis – 10.7%, Candida albicans – 3.6%, contamination: Streptococcus viridians, Corynebacterium sp. – 7.1%. Residual antimicrobial activity in urine was detected in 30.1% of patients.Conclusion. The laser light scattering technology enables a minimal concentration of microorganisms to be detected in a smaller amount of urine or dialysate, which is very important for accelerated diagnosis of urinary tract infections and complications of peritoneal dialysis in children.

Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Urinary tract infections (UTIs) are common pediatric infections and contribute to high morbidity and mortality. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. However, there have been few studies on UTIs in children in Ethiopia, particularly in the east. This study aimed to assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. We conducted hospital-based quantitative study on 332 consecutively selected under-five children from March 20 to June 10, 2021. Parents and guardians were interviewed to collect data using a structured questionnaire. Random urine samples were collected aseptically, and standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into Epi Info version 7 and exported to Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive analysis, bivariate, and multivariable logistic regression analysis. The crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CI) were used to determine the significance of the predictors. A p-value at a 95% confidence interval of less than 0.05 was considered statistically significant. The overall prevalence of bacterial urinary tract infections was 80 (24.1%) 95% CI:19.40-29.00%). Most of the bacterial isolates 55 (68.75%) were gram-negative bacteria, predominantly E. coli 23 (28.75%) and K. pneumoniae 10 (12.50%). Being a rural resident (AOR: 4.10, 95%CI: 1.45 11.54), uncircumcised male (AOR: 3.52, 95%CI: 1.33, 9.39), previous history of antibiotic usage (AOR: 7.32, 95%CI: 2.11, 25.37), indwelling catheterization (AOR: 10.35, 95%CI: 3.74, 28.63), previous history of urinary tract infections (AOR: 5.64, 95% CI: 1.36, 23.38), and urinary frequency (AOR: 5.56, 95%CI: 2.03, 15.25) had higher odds of culture positive result. The majority of the isolates have shown high levels of antibiotic resistance. Meropenem, ciprofloxacin, and amoxicillin-clavulanic acid were effective against gram-negative uropathogens, whereas rifampin and ciprofloxacin were the most sensitive drugs for gram-positive isolates. From the tested bacterial isolates, 53/86 (61.6%), 11/86 (11.6%), and 2/86 (2.3%) were found to have multidrug resistance (MDR), extreme drug resistance (XDR), and pan drug resistance (PDR), respectively. About one-fourth of the children were culture-positive for many types of bacterial uropathogens; this is higher compared with most of the previous studies in Africa. Rural dwellers, uncircumcised males, indwelling catheterization, a history of antibiotic use and urinary tract infection, and frequent urination all had a higher risk of bacterial infections. Many isolates were resistant to multiple drugs, primarily beta-lactams. Urinary tract infections as well as the growth and spread of resistant bacterial pathogens should be monitor regularly.

Constipation as a Risk for Urinary Tract Infection in Children

Constipation as a Risk for Urinary Tract Infection in Children

MP53-06 SPINA BIFIDA-SPECIFIC CRITERIA FOR UTI DIAGNOSIS REFLECT ONLY A SUBSET OF EMPIRIC ANTIBIOTIC USE AMONG CHILDREN WITH SPINA BIFIDA SEEN IN THE EMERGENCY DEPARTMENT

You have accessJournal of UrologyCME1 Apr 2023MP53-06 SPINA BIFIDA-SPECIFIC CRITERIA FOR UTI DIAGNOSIS REFLECT ONLY A SUBSET OF EMPIRIC ANTIBIOTIC USE AMONG CHILDREN WITH SPINA BIFIDA SEEN IN THE EMERGENCY DEPARTMENT Victor M. Kucherov, Teresa L. Russell, Jacob C. Smith, Sally Zimmermann, Elena K. Johnston, M. Sohel Rana, Elaise Hill, Christina P. Ho, Hans G. Pohl, and Briony K. Varda Victor M. KucherovVictor M. Kucherov More articles by this author , Teresa L. RussellTeresa L. Russell More articles by this author , Jacob C. SmithJacob C. Smith More articles by this author , Sally ZimmermannSally Zimmermann More articles by this author , Elena K. JohnstonElena K. Johnston More articles by this author , M. Sohel RanaM. Sohel Rana More articles by this author , Elaise HillElaise Hill More articles by this author , Christina P. HoChristina P. Ho More articles by this author , Hans G. PohlHans G. Pohl More articles by this author , and Briony K. VardaBriony K. Varda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spina bifida (SB)-specific criteria for urinary tract infection (UTI) diagnosis are stricter than those for the general pediatric population in effort to avoid overtreatment. It is unknown how closely these criteria are followed in the emergency department (ED) setting. The objective of this study was to examine the clinical factors associated with initiation of empiric antibiotics for UTI in children with SB seen in the ED. METHODS: A single-institution retrospective database of children with SB (age <21 years) presenting to the ED between 2016 and 2020 was queried. Only encounters with urinalysis (UA) performed were included. The primary outcome was initiation of empiric antibiotics for UTI. Covariables included baseline patient and clinical characteristics. Specific urologic presenting symptoms (fever ≥38°C, abdominal/flank/urethral pain, malodorous/cloudy urine, urinary incontinence) and components of the UA (pyuria [>10 WBC/hpf], nitrites, turbidity, identification of bacteria) were collected. Proportion of patients meeting previously published SB-specific criteria for UTI in the pre-culture setting (≥2 urologic symptoms plus pyuria) were examined. Analysis included descriptive statistics and examining the association between presenting factors with use of empiric antibiotics using multivariable logistic regression. RESULTS: Out of 1,487 encounters, 299 were included comprising 92 unique patients (median 2 encounters per patient, range 1 - 22). Median encounter age was 8 years (range 0.04 – 20). Patients were majority female (60%), Hispanic (55%), and had a myelomeningocele (72%) with supra-sacral lesion (77%). Empiric antibiotics for UTI were initiated in 56%. Only 36% of those receiving antibiotics met SB-specific criteria. Among those receiving antibiotics pyuria was the most common UA finding (88%). When adjusting for covariables, antibiotic use was associated with fever (OR 2.9), cloudy urine (OR 6.5) and the following individual UA components: pyuria (OR 11), nitrites (OR 4.4), urine turbidity (OR 3.5), and bacteria (OR 2.1) (all p<0.05). CONCLUSIONS: Antibiotics were given to about half of children with SB presenting to the ED when a UA was obtained. Receipt of antibiotics was associated with fever and cloudy urine. Among the UA components, pyuria had the strongest association. Only about one third of those receiving antibiotics met the combination of SB-specific criteria for a UTI diagnosis, raising concern for overuse of empiric antibiotics in this population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e714 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Victor M. Kucherov More articles by this author Teresa L. Russell More articles by this author Jacob C. Smith More articles by this author Sally Zimmermann More articles by this author Elena K. Johnston More articles by this author M. Sohel Rana More articles by this author Elaise Hill More articles by this author Christina P. Ho More articles by this author Hans G. Pohl More articles by this author Briony K. Varda More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical, uropathogenic, and radiological profile of culture-positive urinary tract infections in children below 18 months of age

Background: Urinary tract infections (UTIs) are common in children and have the risk of renal scarring. To better identify this at risk group, the following study was carried out to analyze the clinical profile of children below 18 months of age with culture-positive UTI and the outcome of radiological investigations. The primary objective was to assess the clinical profile of culture-positive UTI children and diagnostic yield and correlation between radiological tests. The secondary objectives were to assess the prevalent uropathogens and their antibiogram. Materials and Methods: For this retrospective study, clinical details regarding radiological investigations, prevalent uropathogens and antibiograms, common antibiotics used in treatment, and uroprophylaxis were obtained through electronic medical records in children &lt;18 months of age admitted with culture-positive UTI. Results: In 225 children seen over a period of 36 months, a slight male predominance (56%) was observed. Ultrasonography (USG) was done in nearly all children, micturating cystourethrography (MCU) was performed in only 40% of patients, dimercaptosuccinic acid (DMSA), performed after 6 months of the index UTI, in one-fifths of the patients. All three investigations were performed in one out of six children. USG and MCU used in combination detected the highest number of significant abnormalities (39%) compared to USG and DMSA (32%). Escherichia coli was the predominant uropathogen identified. Significant meropenem resistance (52%) was observed in the community-acquired UTI. Conclusion: The evaluation and follow-up of infants and young children with UTI show inadequate radiological evaluation, which could increase the risk of undetected and untreated renal sequelae.