Pediatric Urinary Tract Infections

Department of Emergency Medicine, Georgetown University Hospital, Washington, DC 20007, USA.
Emergency medicine clinics of North America (Impact Factor: 0.78). 08/2011; 29(3):637-53. DOI: 10.1016/j.emc.2011.04.004
Source: PubMed


Urinary tract infections (UTIs) in children are commonly seen in the emergency department and pose several challenges to establishing the proper diagnosis and determining management. This article reviews pediatric UTI and addresses epidemiology, diagnosis, treatment, and imaging, and their importance to the practicing emergency medicine provider. Accurate and timely diagnosis of pediatric UTI can prevent short-term complications, such as severe pyelonephritis or sepsis, and long-term sequelae including scarring of the kidneys, hypertension, and ultimately chronic renal insufficiency and need for transplant.

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    • "The mammalian urinary tract can be infected by several pathogenic microbes, leading to inflammation of the urethra (urethritis), bladder (cystitis) and kidneys (pyelonephritis ) and to formation of urinary stones. Urinary tract infections (UTIs) can occur in infants and small children, in adolescent and adult women, and in older adults or patients fitted with urinary catheters (Bhat et al. 2011; Hooton 2012; Nicolle 2012). The primary causes of UTIs in adolescent and adult women are the Gram-negative bacteria Escherichia coli and Proteus mirabilis (Ronald 2002; Nielubowicz and Mobley 2010) and the Gram-positive bacterium Staphylococcus saprophyticus (Rupp et al. 1992; Raz et al. 2005). "
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    ABSTRACT: Unlabelled: Urease is a virulence factor for the Gram-positive urinary tract pathogen Staphylococcus saprophyticus. The susceptibility of this enzyme to chemical inhibition was determined using soluble extracts of Staph. saprophyticus strain ATCC 15305. Acetohydroxamic acid (Ki = 8.2 μg ml(-1) = 0.106 mmol l(-1) ) and DL-phenylalanine hydroxamic acid (Ki = 21 μg ml(-1) = 0.116 mmol l(-1) ) inhibited urease activity competitively. The phosphorodiamidate fluorofamide also caused competitive inhibition (Ki = 0.12 μg ml(-1) = 0.553 μmol l(-1) = 0.000553 mmol l(-1) ), but the imidazole omeprazole had no effect. Two flavonoids found in green tea extract [(+)-catechin hydrate (Ki = 357 μg ml(-1) = 1.23 mmol l(-1) ) and (-)-epigallocatechin gallate (Ki = 210 μg ml(-1) = 0.460 mmol l(-1) )] gave mixed inhibition. Acetohydroxamic acid, DL-phenylalanine hydroxamic acid, fluorofamide, (+)-catechin hydrate and (-)-epigallocatechin gallate also inhibited urease activity in whole cells of strains ATCC 15305, ATCC 35552 and ATCC 49907 grown in a rich medium or an artificial urine medium. Addition of acetohydroxamic acid or fluorofamide to cultures of Staph. saprophyticus in an artificial urine medium delayed the increase in pH that normally occurs during growth. These results suggest that urease inhibitors may be useful for treating urinary tract infections caused by Staph. saprophyticus. Significance and impact of the study: The enzyme urease is a virulence factor for the Gram-positive urinary tract pathogen Staphylococcus saprophyticus. We have shown that urease activity in cell-free extracts and whole bacterial cells is susceptible to inhibition by hydroxamates, phosphorodiamidates and flavonoids, but not by imidazoles. Acetohydroxamic acid and fluorofamide in particular can temporarily delay the increase in pH that occurs when Staph. saprophyticus is grown in an artificial urine medium. These results suggest that urease inhibitors may be useful as chemotherapeutic agents for the treatment of urinary tract infections caused by this micro-organism.
    Full-text · Article · Sep 2013 · Letters in Applied Microbiology
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    • "Gram-positive pathogens include group B Streptococcus and Enterococcus in neonates and infants, and Staphlococcus saprophyticus in adolescent girls [14]. Fungal infections are much less common and are usually to those who are immune-compromised or diabetic, are on long-term antibiotics, or have long-term indwelling catheter [5, 15]. Often urine is contaminated by Lactobacillus species, Corynebacterium spp., coagulase-negative staphylococci, and α hemolytic streptococci [5]. "
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    ABSTRACT: Urinary tract infections remain the most common bacterial infection in childhood. Escherichia coli is responsible for over 80% of Pediatric UTIs. Other common gram negative organisms include Kleibsiella, Proteus, Enterobacter and occasionally Pseudomonas. Signs and symptoms vary greatly by age of the patient becoming more specific as the child grows older. Even in the absence of specific signs a UTI should be included in the differential diagnosis of high grade fever. In younger children, presence of upper respiratory infections, otitis media or gastroenteritis does not eliminate the possibility of a UTI. Culture of the urine remains the gold standard for diagnosing UTIs. All males and females with well documented UTIs should be imaged for the presence of urological anomalies associated with UTI. Depending on patient's clinical symptoms and tolerance, therapy can be oral or parenteral as they have both been found equally efficacious. Healthcare professionals should ensure that when a child or young person has been identified as having a suspected UTI, they and their parents are given information about the need for treatment, the importance of completing any course of treatment and advice about prevention and possible long-term management.
    Full-text · Article · Jul 2012 · International Journal of Pediatrics
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    ABSTRACT: The need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management. We evaluated the sensitivity, specificity, negative and positive predictive value of automated microscopy IRIS iQ200 combined with the dipstick analyses in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score. Of 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age <1 year (p<0.001), leukocyte esterase ≥ 15×10^6/L (p<0.001), number of small particles (ASP) ≥ 5500 × 10^6/L (p<0.001) and bacteria ≥ 3 × 10^6/L (p=0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72-0.85), and was better than those of the individual urinary chemical and microscopic analyses. This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.
    Full-text · Article · Nov 2011 · Clinica chimica acta; international journal of clinical chemistry
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