Urinary Tract Infection In Children Research Articles

Has the COVID-19 Pandemic Affected Community-Acquired Urinary Tract Infections in Children?

To evaluate whether there were any changes in the rates of urinary tract infection (UTI) and antibiotic resistance in pediatric patients during the pandemic period. Urine culture samples collected due to suspected UTI were searched retrospectively from our hospital database, and the patients with growth in urine culture were identified. They were divided into 2 groups as Group A (before COVID-19, March 11, 2019- March 11, 2020) and Group B (COVID-19 period, March 11, 2020- March 11, 2021). Also, COVID-19 period was divided into 3 subgroups (March 2020- June 2020: first epidemic peak, July 2020 - November 2020: normalization process, December 2020- March 2021: second epidemic peak). We adjusted the patient age as <1, 1-6 and 7-18 years. Age, gender, microorganism strain types, and their antibiotic resistance patterns were compared between the 2 groups Results: This cross-sectional study included 250 eligible patients (Group A, n=182 and Group B, n=68) with a mean age of 10.91 ± 5.58 years. The male/female ratio was higher in Group B than in Group A (p = .004). Incidence of UTIs was lower in the curfew and restriction periods due to epidemic peaks than normalization process (p = .001). The proportion of E.coli decreased from 80.2% to 61.8% during the pandemic period when compared to pre-pandemic period (p = .001). Group B had lower rates of resistance to ampicillin, fosfomycin and nitrofurantoin for E.coli than Group A (p = .001, p = .012 and p = .001, respectively). Also, Group B had higher rate of uncommon microorganisms and lower rate of resistance to nitrofurantoin for E.coli than Group A in patients aged 7-18 years (p = .003 and p = .023, respectively). Our study demonstrates that the ongoing COVID-19 pandemic process has caused alterations in community-acquired UTIs in children. More hygienic lifestyle may be considered as the main factor in this change.

Prevalence and antimicrobial sensitivity of asymptomatic bacteriuria among sickle cell anaemia patients in Aminu Kano Teaching Hospital, Nigeria

Introduction: Urinary tract infection (UTI) is a common cause of morbidity in children with sickle cell anaemia (SCA) and may present as asymptomatic bacteriuria. Asymptomatic bacteriuria is often under-diagnosed and may lead to long term renal complications.&#x0D; Aim: This study compared the prevalence of asymptomatic bacteriuria, bacterial isolates and their antimicrobial sensitivity in children with and without SCA seen at Aminu Kano Teaching Hospital.&#x0D; Subjects and Methods: This cross-sectional study recruited 139 children with SCA in stable state and 139 children without SCA aged 1- 15 years. All children were tested for asymptomatic bacteriuria using clean catch or mid-stream urine samples. Children whose samples yielded significant bacteriuria (≥105cfu/ml) had a repeat urine culture within a week to confirm asymptomatic bacteriuria.&#x0D; Results: Both study groups had a mean age of 4.25 years ± 3.04, and a male: female ratio of 1.4:1. The prevalence of asymptomatic bacteriuria was higher in children with SCA(5.8%) compared to children without SCA (1.4%). Asymptomatic bacteriuria was more common among females in both study groups. The most common isolate in both groups was E. coli. Majority of the isolates were sensitive to quinolones, gentamycin and nitrofurantoin but resistant to commonly used antibiotics like amoxicillin and cotrimoxazole.&#x0D; Conclusion: Asymptomatic bacteriuria is more common in children with SCA than those without SCA. Majority of isolated pathogens showed low susceptibility to ampicillin, amoxicillin, cotrimoxazole and nalidixic acid, this implies that the use of these drugs for empirical or first line treatment for UTI in children with SCA should be avoided.

Risk factors for community acquired pediatric urinary tract infection with extended-spectrum-β-lactamase Escherichia coli - A case-control study

Community-acquired (CA) infections caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli urinary tract infections (UTI) have become increasingly prevalent, posing a serious threat to public health. Risk factors for ESBL UTI have not been extensively studied in the pediatric population. We report findings from a case control study to identify risk factors for CA ESBL-producing E. coli UTI in children. A cohort of children with CA ESBL Escherichia coli UTI evaluated at a tertiary referral hospital from January 2014 through April 2021, were matched 1:3 with control group of non-ESBL CA E. coli UTI based on age at first episode of non-ESBL UTI. To identify potential risk factors for ESBL E. coli UTI, conditional logistic regression model was utilized accounting for age matching. Univariate models were fitted for each clinical risk factor. Factors found to be significantly associated with ESBL UTI were simultaneously included in a single model to check for associations adjusted for all other factors. On conditional multivariate analyses for univariate testing, male sex (P=0.021), history of Urology care (P=0.001), and antibiotic treatment within 30 days prior to positive culture (P=0.004) were identified as independent risk factors for CA ESBL E. coli UTI. Comorbidity scores were assigned to each patient according to pediatric comorbidity index (PCI); children with ESBL UTI were more likely to have higher morbidity risk than non-ESBL UTI children (P<0.001). From the logistic model, the higher the morbidity scores, the more likely children will have CA ESBL UTI (P<0.001). Identifying risk factors for ESBL-producing E. coli UTI in children is important because of limited therapeutic options. This knowledge is essential for clinical decision making and to develop intervention strategies to reduce disease burden. Our study found that although females have an increased predisposition to UTIs, we observed that the male sex is an independent risk factor for ESBL E. coli UTI. This finding warrants further investigation to determine underlying cause. Because of the retrospective design of the study, collection of data from a single center, and differences in characteristics between patient populations, treatments, and prescribing patterns in the community, this study may not be generalizable. Findings from our case-control study suggest that the male sex, history of Urology care, and previous antibiotic exposure are independent risk factors for CA ESBL-GNB UTI. Children with ESBL E. coli UTI are more likely to have longer admission duration and higher comorbidity index.

Prevalence of renal scaring caused by urinary tract infections in children: a systematic review and meta-analysis.

Urinary tract infection (UTI) is the second most common infection in children, the most important complication of which is renal scarring. The aim of present study was to evaluate the prevalence of renal scarring after UTI in children through systematic review and meta-analysis. The international databases of Science Direct, PubMed, Scopus, and Web of Science and the Google Scholar search engine were searched using standard keywords. The sources found were from 2010 to 2020 and the search stage was updated until 2021.02.16. Data were analyzed using STATA-14 software and the significance level was considered at P<0.05. In 29 studies with a sample size of 9,986 children, the prevalence of renal scarring in children was estimated at 35% (95% CI: 29-41). Also, the prevalence of renal scarring was in girls 61% (95% CI: 40-81) and in boys 34% (95% CI: 11-57). The prevalence of unilateral renal scarring in children was 56% (95% CI: 48-65) and bilateral renal scarring was 31% (95% CI: 14-48). In addition, the prevalence of scar was 54% in children with reflux and 12% in children without vesicoureteral reflux. More than one third of people under the age of 18 after UTI have renal scarring. The prevalence of this complication in girls is about 2 times higher than that in boys and in people with reflux, it is about 4 times higher than people who do not have urinary reflux. Also, about half of people under the age of 18 suffer from unilateral renal scarring and about one third of them suffer from bilateral renal scarring.

Prevalence of renal scaring caused by urinary tract infections in children: a systematic review and meta-analysis

PURPOSE. SOURCES OF INFORMATION. Urinary tract infection (UTI) is the second most common infection in children, the most important complication of which is renal scarring. The aim of present study was to evaluate the prevalence of renal scarring after UTI in children through systematic review and meta-analysis. METHODS. The international databases of Science Direct, PubMed, Scopus, and Web of Science and the Google Scholar search engine were searched using standard keywords. The sources found were from 2010 to 2020 and the search stage was updated until 2021.02.16. Data were analyzed using STATA-14 software and the significance level was considered at PRESULTS. In 29 studies with a sample size of 9,986 children, the prevalence of renal scarring in children was estimated at 35% (95% CI: 29-41). Also, the prevalence of renal scarring was in girls 61% (95% CI: 40-81) and in boys 34% (95% CI: 11-57). The prevalence of unilateral renal scarring in children was 56% (95% CI: 48-65) and bilateral renal scarring was 31% (95% CI: 14-48). In addition, the prevalence of scar was 54% in children with reflux and 12% in children without vesicoureteral reflux. CONCLUSIONS. More than one third of people under the age of 18 after UTI have renal scarring. The prevalence of this complication in girls is about 2 times higher than that in boys and in people with reflux, it is about 4 times higher than people who do not have urinary reflux. Also, about half of people under the age of 18 suffer from unilateral renal scarring and about one third of them suffer from bilateral renal scarring

Effect of Educational intervention based on Health Belief Model on promoting preventive behaviours of urinary tract infections in mothers with children under 6-Years of age

BackgroundChildren are one of the most vulnerable social groups to infectious diseases, and prevention of urinary tract infections in children is very important; therefore, the present study aimed to investigate the effect of education based on health belief model (HBM) on promoting preventive behaviours of urinary tract infection in mothers with children under 6-years of age.MethodsThis quasi-experimental study was conducted on 150 women with children under 6 years of age referred to health centers in Fasa city, Iran in 2021. Subjects were selected using simple sampling method and were randomly divided into intervention (n = 75) and control (n = 75) groups. The educational intervention for the experimental group consisted of 6 virtual training sessions of 40–50 min using lecture, question and answer, group discussion and video clips. Two virtual follow-up sessions were also held one month and two months after the educational intervention. Three months after the educational intervention, both experimental and control groups completed the questionnaire. Data were analysed by using SPSS 22 through Chi-square, independent t-test, and paired t-test (p > 0.05).ResultsBefore the intervention, based on independent t-test and paired t-test, the mean score of HBM constructs were not significantly different between the control and intervention groups (P > 0.05). However, while perceived barriers significantly decreased (P < 0.05) after the intervention, the mean score of knowledge, ‌ perceived sensitivity and severity, perceived benefits, ‌ self-efficacy, cues to action, and performance significantly increased (P < 0.05) after the intervention.ConclusionConsidering the effect of training preventive behaviours of urinary tract infection based on HBM, application of the model as an effective and cost-effective method along with other methods is recommended for educational programs of mothers with children under 6 years of age.

Urinary tract infections in children: A guide for primary care nurses

Margaret Perry explains what nurses need to know when children present with this common condition

Determine the Mean Levels of Vitamin D in Children with First Episode of Urinary Tract Infection

Urinary tract infections (UTI) have a prevalence of 1% in boys and about 1-3% in girls. It is more common in boys under 1 year of age after which the incidence is higher in girls. Vitamin D is a fat-soluble vitamin that is synthesized in the skin epithelial cells and also obtained from diet. It has an important role in bone formation and deficiency of vitamin D leads to rickets in children. Objective: To determine the mean levels of vitamin D in children with first episode of urinary tract infection. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Study was conducted at Department of pediatrics, Fauji Foundation Hospital Rawalpindi from 16th Nov, 2021 to 16th May, 2022. Materials and Methods: 50 patients fulfilling the criteria for first episode of urinary tract infection included. All patients age, gender, height and weight were noted. Samples were inoculated on culture media and were examined at 24-48hrs for colony counts and bacterial identification. All patients who were tested positive for urinary tract infection had their serum Vitamin D 25(OH) D3 levels done, a deficiency was defined as values of less than 25ng/ml. Data was entered and analysed in SPSS version 22.0 Results: Mean age (6.70+3.9) with ranges from 02 to 12 years and Mean height (cm) and weight (kg) were (121.76+31.58), (25.64+12.36) respectively. There were 12 (24.0) male and 38 (76.0) female patients who were included in the study according to the inclusion criteria. Mean vitamin-D levels in children with first episode of urinary tract infection in the study was (23.46+1.68). Mean vitamin-D levels in children with first episode of urinary tract infection in children ages 02-06 years was (23.36+1.36), whereas mean vitamin-D levels in children ages 7 – 12 years was (23.54+1.91), Mean vitamin-D levels in among male and female children with first episode of urinary tract infection was (22.83+1.26) ( 23.66+1.76) which was statistically not significant (p-value 0.139). Mean vitamin-D levels in children with first episode of urinary tract infection in children have height between 101 – 175 cm, was (23.50+1.18). Mean vitamin-D levels in children with first episode of urinary tract infection in children having weight between 21 – 50 kg was (23.63+1.88). Conclusion: The study concluded that average vitamin D deficiency was substantial among children with urinary tract infection. Keywords: Urinary tract infections. Vitamin D levels, E coli

Intravesical gentamicin instillation in the prevention of recurrent urinary tract infections in children with neurogenic bladder- a single-center retrospective observational study

Recurrent urinary tract infections (UTI) in children with neurogenic bladder (NGB) put them at high risk of morbidity and mortality from urosepsis and end-stage renal disease (ESRD). Since the efficacy of low-dose prophylactic antibiotics to prevent these recurrences has been declining since the emergence of extended-spectrum beta-lactamase (ESBL) organisms, intravesical gentamicin instillation has also been used, but only scarce data in children is available in the literature. We evaluate the efficacy of intravesical gentamicin instillation to reduce UTIs in children with NGB, compare it with oral antibiotic prophylaxis and determine its effect on pathogens resistance to antibiotics. Retrospective observational study of 17 children with NGB managed in a tertiary center. Intravesical gentamicin instillation followed an initial period of oral antibiotic prophylaxis. In a conditional negative binomial regression model, a matched comparison of the rate of UTIs, the identified pathogens and their antibiotics susceptibility between the two therapies was performed for each individual child, RESULTS: When compared to antibiotic prophylaxis, intravesical gentamicin instillation showed no significant difference in the yearly rate of UTI, symptomatic UTI, or admissions for intravenous antibiotic therapy. However, it was associated with a 38% reduction in the incidence rate ratio of UTI (p=0.04) and 75% of asymptomatic UTI (p=0.006) After intravesical gentamicin instillation, five children (31%) had a gentamicin-resistant UTI, similar to before that treatment (p=0.76). Although the overall rate of UTI and of asymptomatic infections were significantly lower with intravesical gentamicin instillation than during oral antibiotic therapy, there was no significant difference in the rate of symptomatic UTIs or UTIs requiring admissions, probably because of the small sample size. In addition, neither an emergence of ESBL pathogens nor the rate of pathogens resistance to gentamicin was observed with intravesical gentamicin instillation. As to the potential nephrotoxicity of aminoglycosides, the calculated GFR for all children remained normal. Strengths of our study include the use of a matched paired comparison of each participant with him/herself with each treatment modality, thus eliminating potential confounding by some individual characteristics. In addition, and unlike previous studies, we have also used a robust multivariate statistical analysis to compare counts and rates of outcomes. Limitations include the absence of gentamicin serum levels monitoring, of hearing testing, and also the small sample size. Intravesical gentamicin instillation decreases the overall rate of UTI and asymptomatic infections in children with NGB without increasing the rate of bacterial resistance to gentamicin.

Urinary tract infection in children and adults: modern approaches to prevention and treatment (literature review)

Urinary tract infection occupies a leading place in the structure of uronof our own research, alternative approaches to complex therapy and prevention of various variants of the course of urinary tract infection are presented. At the stages of patient rehabilitation, special attention is paid to diet therapy, the use of modern phytopreparations, the preservation of the mucous microbiota, and immunomodulatory therapy.ephrological pathology in children and adults. Based on the analysis of literature data and the results.

Fungal Urinary Tract Infections in Pediatric Age Groups

One of the most prevalent and recurring bacterial diseases in kids is urinary tract infections (UTI). At least 8% of girls and 2% of boys are thought to suffer UTIs as children. The fungi are often linked to UTIs, and their antibiotic susceptibility patterns change over time and across various environments. To choose the best empirical antimicrobial therapy, it is crucial to understand the trends of uropathogenic antibiotic resistance in certain geographic areas. Therefore, this research assesses the causal organisms in urine samples and their antibiotic susceptibility profile among patients who visit Mosul's general outpatient department clinic. Due to space restrictions, our research primarily focused on fungus-related UTIs in children (2–12) years old. . Adult infections, reflux nephropathy, catheter-associated and nosocomial infections, medication assessment for particular antimicrobials, and viral and rickettsial infections are only a few examples of the subjects covered. The study intends to close a gap in the literature about how candiduria manifests in pediatric inpatients and outpatients. The current study's objective was to ascertain the prevalence of candiduria among kids visiting External laboratories in Mosul, Iraq. Additionally, isolates' sensitivity to several antifungal medications was taken into consideration.

Renal scars in children with febrile urinary tract infection - Looking for associated factors

Febrile urinary tract infection (UTI) is a common childhood infection related to renal scarring and potentially long-term complications like chronic kidney disease. It would be of great benefit to find a correlation between easy-accessible factors in the acute phase of a febrile UTI and the development of renal scar formation and/or decreased renal function in order to identify children at risk of future complications. The aim of this study was to identify factors associated with the development of decreased split renal function (DSRF) and/or permanent renal scar formation in children with febrile UTI. The medical records of 212 Children aged 0 months to 15 years with febrile UTI admitted to The Pediatric Department of Lillebaelt Hospital, Kolding from January 2011 to September 2014 were systematically reviewed. We analyzed clinical, laboratory, and radiologic findings. Statistical analysis was performed to identify factors associated with renal scar formation and DSRF on nuclear imaging at 6 months follow-up. A total of 113 medical records were eligible for further analysis, 99 girls and 14 boys, 34 patients younger than 12 months. In total 30 patients (26.5%) had an abnormal follow-up imaging (DSRF less than 45% and/or renal scarring). Nine patients (8%) had renal scarring. Four patients (3.5%) had renal scarring only, 21 patients (18.6%) had DSRF only, and five patients (4.4%) had both renal scarring and DSRF. Patients with renal scar formation on follow-up imaging had significantly higher C-reactive protein (CRP) than patients with no scarring (p<0.01). CRP and absolute neutrophil count (ANC) was significantly higher in patients with abnormal follow-up imaging (p<0.01 and p=0.010), and these patients more often had positive nitrite in urine dipstick compared to patients with normal kidneys on follow-up (p=0.048). Temperature above 38.5°C and CRP >50mg/L in combination were also associated with a higher risk of abnormal follow-up imaging (p=0.016). This study contributes with further knowledge to the ongoing debate regarding renal scarring but also reveals the possibility of associated factors for the development of DSRF following a febrile UTI in children. However, due to the retrospective design as well as the small number of events in our study definite conclusions on whether the above-mentioned factors are indeed prognostic for the development of renal scarring or DSRF following a febrile UTI can not be drawn.

How Covid-19 changed the epidemiology of febrile urinary tract infections in children in the emergency department during the first outbreak

BackgroundThe first Covid-19 pandemic affected the epidemiology of several diseases. A general reduction in the emergency department (ED) accesses was observed during this period, both in adult and pediatric contexts.MethodsThis retrospective study was conducted on the behalf of the Italian Society of Pediatric Nephrology (SINePe) in 17 Italian pediatric EDs in March and April 2020, comparing them with data from the same periods in 2018 and 2019. The total number of pediatric (age 0–18 years) ED visits, the number of febrile urinary tract infection (UTI) diagnoses, and clinical and laboratory parameters were retrospectively collected.ResultsThe total number of febrile UTI diagnoses was 339 (73 in 2020, 140 in 2019, and 126 in 2018). During the first Covid-19 pandemic, the total number of ED visits decreased by 75.1%, the total number of febrile UTI diagnoses by 45.1%, with an increase in the UTI diagnosis rate (+ 121.7%). The data collected revealed an increased rate of patients with two or more days of fever before admission (p = 0.02), a significant increase in hospitalization rate (+ 17.5%, p = 0.008) and also in values of C reactive protein (CRP) (p = 0.006). In 2020, intravenous antibiotics use was significantly higher than in 2018 and 2019 (+ 15%, p = 0.025). Urine cultures showed higher Pseudomonas aeruginosa and Enterococcus faecalis percentages and lower rates of Escherichia coli (p = 0.02).ConclusionsThe first wave of the Covid-19 pandemic had an essential impact on managing febrile UTIs in the ED, causing an absolute reduction of cases referring to the ED but with higher clinical severity. Children with febrile UTI were more severely ill than the previous two years, probably due to delayed access caused by the fear of potential hospital-acquired Sars-Cov-2 infection. The possible increase in consequent kidney scarring in this population should be considered.

Evaluation of the Knowledge and Awareness Level of the Pediatric Residents About the Diagnosis, Treatment and Follow-up of Urinary Tract Infection in Children

Objective: In this study, we sought to assess pediatric residents’ level of knowledge about the diagnosis, treatment, and follow-up of urinary tract infection in children. Methods: This survey was a descriptive study applied to pediatric residents. In the study, a questionnaire form prepared by researchers consisting of questions about socio-demographic features, about the diagnosis, treatment, and follow-up of urinary tract infection in children was used. Results: Eighty-eight physicians participated in this research. The percentage of participants who correctly indicated urine culture based on the results of routine urinalysis in the diagnosis of urinary tract infection ranged from 95.5% to 96.6. 54.5% of participants (n=48) correctly identified the indication for ultrasonography in children with acute urinary tract infection. 67.0% (n=59) of the participants answered that Mercaptuacetyltriglycin was not appropriate for initial evaluation of recurrent urinary tract infection under the age of one year, while 33.0% (n=29) answered the question incorrectly. In clinical scenarios, 48.9% (n=43.0) participants made the proper decision for treatment of extended spectrum beta-lactamase-positive E. coli treatment. Conclusion: In conclusion, pediatric residents had appropriate training and experience in the diagnosis of urinary tract infection in children. However, over half of the residents lacked sufficient training in the management of resistant bacteria and additional radiological imaging techniques. Considering this, we believe it will be good to keep the knowledge updated concerning the treatment and follow-up of children with urinary tract infection through in-service training and post-graduate education.

Urinary tract infections in children - a review

Introduction and purpose:&#x0D; Urinary tract infection (UTI) is very common, mostly bacterial infection in childhood. UTI may affect the lower urinary tract or the upper urinary tract. Infection typically require antibiotics for treatment. &#x0D; Brief description of the state of knowledge: &#x0D; The prevalence of urinary tract infection is between 2 and 8% and it is more common in female, infants and uncircumcised male infants. Most paediatric UTIs are caused by Gram negative bacteria Escherichia coli (E.coli). Symptoms of this infection are nonspecific and may be confused with signs of other clinical conditions. The most common symptoms are suprapubic pain, back pain, dysuria, urinary frequency and systemic symptoms such as fever, vomiting, lethargy. Antibiotics are the standard treatment for urinary tract infections. &#x0D; Conclusion: &#x0D; This article reviews basic informations, epidemiology, clinical presentation, diagnosis and treatment of urinary tract infection.

The pathogenetic role of some cytokines in the development and course of various clinical forms of urinary tract infections in children

Background. The purpose of the research: to study the content of interleukin-6 and interleukin-15 cytokines in the blood serum of children with urinary tract infection and to establish their pathogenetic role in the development of various clinical forms of the disease. Materials and methods. The study groups consisted of 84 children (mean age of 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 17 children with acute pyelonephritis, the second — 21 patients with chronic pyelonephritis, the third — 16 children with acute cystitis, the fourth subgroup — 10 patients with unspecified urinary tract infections. The control group included 20 relatively healthy children. The content of interleukin-6 and interleukin-15 was evaluated by enzyme-linked immunosorbent assay. Results. It was established that the development of acute urinary tract infections was accompanied by a high level of serum pro-inflammatory interleukin-6. We found the highest level in children with cystitis, which exceeded that of the control group by 2.8 times (р &lt; 0.01). In children with acute pyelonephritis, this cytokine was 1.8 times higher (р &lt; 0.05). However, patients with chronic pyelonephritis had only a tendency towards its increase (p &gt; 0.05). Interleukin-15 in the main group was statistically higher than in controls (р &lt; 0.05). In children of subgroups 3 and 4, its level did not differ from that of the control group (p &gt; 0.05). However, in subgroups 1 (р &lt; 0.05) and 2 (р &lt; 0.01), we observed a statistically significant increase in interleukin-15 level. A direct correlation between interleukin-15 content and disease duration (r = 0.64, р &lt; 0.05) was also found. Conclusions. The development of an acute inflammatory process in the urinary tract in children occurs against the background of a marked increase in the expression of interleukin-6, while a chronic inflammatory process develops with a statistically significant increase in the level of interleukin-15 in blood serum.

Strategies for selection and application of antibiotics for urinary tract infections in children

泌尿系统感染（UTI）是儿童期常见的感染性疾病之一，大肠埃希菌是其最常见致病菌。抗菌药物治疗应在留取患儿尿液后尽早开始。治疗UTI的经验性首选药物为二代或三代头孢菌素和阿莫西林克拉维酸。临床上应根据患儿年龄、疾病严重程度以及能否耐受口服药物等情况综合考虑，选择口服或静脉治疗。预防用抗菌药物则推荐首选呋喃妥因和甲氧苄啶-磺胺甲噁唑。.

Parental Knowledge and Awareness of Childhood Urinary Tract Infections: A Cross Sectional Survey.

BackgroundParent’s misconceptions or lack of knowledge about childhood urinary tract infections (UTIs) can negatively impact their children’s health. Therefore, the present study aimed to determine the childhood urinary tract infections awareness and understanding among parents in Saudi Arabia.Patients and MethodsAn online validated cross-sectional survey of parents in Saudi Arabia was conducted from August to September 2021. Study participants who met the inclusion criteria were selected using a convenience sampling technique. A questionnaire with two domains was used to assess parental awareness of childhood urinary tract infection symptoms, complications, treatment, prevention, epidemiology, and diagnosis. The total childhood urinary tract infections awareness scores were classified into three categories: low awareness, moderate awareness, and high awareness. Descriptive statistics were used to determine the data distribution. A chi-square test was used to evaluate the relationship between parental awareness about urinary tract infections in children and other variables. Statistical significance was established at 0.05.ResultsOf the 1688 parents who completed the survey, 1289 (76.4%) were female, 1581 (93.7%) were married, and 1161 (68.8) had a university degree. Parent’s total awareness scores were high; however, individual domain scores indicate a moderate level of knowledge. Statistically significant relationship were observed between total awareness and gender, occupation, and level of educational level ((P=0.004, P=0.001, P=0.007, respectively). Another statistically significant relationship was noted between the history of urinary tract infections and awareness of disease prevention (P=0.009).ConclusionIn Saudi Arabia, parental knowledge about childhood urinary tract infections is moderate to high. However, future studies are needed to investigate gender, educational, and occupational variations in childhood UTI knowledge among parents in Saudi Arabia.

The level of antimicrobial peptides in different clinical forms of urinary tract infections in children

The aim. To study the content of antimicrobial peptides in the serum of children with urinary tract infections depending on the clinical form of the disease and to establish their pathogenetic role in the development of various clinical forms of pathology. Materials and methods. The study groups consisted of 84 children (mean age – 10.0 ± 1.3 years). The main group was divided into subgroups: the first subgroup – 17 children with acute pyelonephritis, the second subgroup – 21 patients with chronic pyelonephritis, the third subgroup – 16 patients with acute cystitis, the fourth subgroup – 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The study of the content of cathelicidin, hepcidin and lactoferrin was performed by enzyme-linked immunosorbent assay. Results. The development of urinary tract infection was accompanied by a statistically significant increase in the content of cathelicidin (P &lt; 0.05). The highest level of serum cathelicidin was registered in children of the first (P &lt;0.05) and third subgroups (P &lt; 0.05). In the other two subgroups, the level of LL-37 had only a trend towards increasing (P &gt; 0.05). The level of hepcidin in the main study group was statistically lower than in the control group (P &lt; 0.05). The development of chronic pyelonephritis and acute cystitis occurred amid a statistically significant decrease in hepcidin levels by 2.5 and 1.7 times (P &lt; 0.01 and P &lt; 0.05, respectively). The level of lactoferrin in the general group was within the control group figures (P &gt; 0.05), however, there was a statistically significant decrease in serum lactoferrin in a subgroup of children with unspecified urinary tract infections (P &lt; 0.05). We determined a relationship between hepcidin and lactoferrin levels in the investigated groups and found a clear direct relationship in a subgroup of children diagnosed with chronic pyelonephritis (r = 0.58, P &lt; 0.01). Conclusions. Each nosological form of urinary tract infection has its own configuration of antimicrobial peptides. The analysis of the relationship between hepcidin and lactoferrin, the antimicrobial peptides that limit the access of the pathogens to serum iron, indicates the synchronization of the body’s defense mechanisms aimed at eliminating the pathogen.

Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data

BackgroundDiagnosing urinary tract infections (UTIs) in children in the emergency department (ED) is challenging due to the variable clinical presentations and difficulties in obtaining a urine sample free from contamination. Clinicians need to weigh a range of observations to make timely diagnostic and management decisions, a difficult task to achieve without support due to the complex interactions among relevant factors. Directed acyclic graphs (DAG) and causal Bayesian networks (BN) offer a way to explicitly outline the underlying disease, contamination and diagnostic processes, and to further make quantitative inference on the event of interest thus serving as a tool for decision support.MethodsWe prospectively collected data on children present to ED with suspected UTIs. Through knowledge elicitation workshops and one-on-one meetings, a DAG was co-developed with clinical domain experts (the Expert DAG) to describe the causal relationships among variables relevant to paediatric UTIs. The Expert DAG was combined with prospective data and further domain knowledge to inform the development of an application-oriented BN (the Applied BN), designed to support the diagnosis of UTI. We assessed the performance of the Applied BN using quantitative and qualitative methods.ResultsWe summarised patient background, clinical and laboratory characteristics of 431 episodes of suspected UTIs enrolled from May 2019 to November 2020. The Expert DAG was presented with a narrative description, elucidating how infection, specimen contamination and management pathways causally interact to form the complex picture of paediatric UTIs. Parameterised using prospective data and expert-elicited parameters, the Applied BN achieved an excellent and stable performance in predicting Escherichia coli culture results, with a mean area under the receiver operating characteristic curve of 0.86 and a mean log loss of 0.48 based on 10-fold cross-validation. The BN predictions were reviewed via a validation workshop, and we illustrate how they can be presented for decision support using three hypothetical clinical scenarios.ConclusionCausal BNs created from both expert knowledge and data can integrate case-specific information to provide individual decision support during the diagnosis of paediatric UTIs in ED. The model aids the interpretation of culture results and the diagnosis of UTIs, promising the prospect of improved patient care and judicious use of antibiotics.