Bacteriuria in Children with Special Reference to Structural Abnormalities of Urinary Tract
Journal of Pediatric Nephrology,
Vol. 8 No. 1 (2020),
,
Page 1-7
https://doi.org/10.22037/jpn.v8i1.29701
Abstract
Background and Aim: Urinary tract infection (UTI) can lead to adverse renal outcomes in the form of renal scarring and its consequences in children. Underlying congenital abnormalities of the kidney and urinary tract (CAKUT) play a crucial role in UTI recurrence and its outcome.
Methods: This study was conducted to evaluate children aged 1 month to 18 years with bacteriuria retrospectively to assess recent trends of antimicrobial resistance, underlying structural abnormalities of the urinary tract, and severity of symptoms associated with it. Ultrasonography was done in children under 2 years with a history of recurrent UTI to exclude associated structural abnormalities of the urinary tract.
Results: Of 255 studied children, 58% were female. Ultrasonography of the kidney and bladder was performed in 116 children, which revealed CAKUT in 38% (n=44). Children with CAKUT commonly presented with fever (36%) alone or in combination with other features. The most common pathogen was E coli (60%), which was very sensitive to intravenous aminoglycosides (95-100%) and carbapenems (96%) but had less sensitive to cephalosporins (43%). E coli showed higher resistance to oral cephalosporins and quinolones (62% and 54%, respectively). E coli had a high (93%) and Klebsiella spp had a low (63%) sensitivity to nitrofurantoin.
Conclusion: This study revealed that about one fifth of the children with bacteriuria had CAKUT. A higher resistance pattern was observed to commonly used oral antimicrobial agents, which eventually narrows down the choice of empirical antibiotic.
Keywords: Child; Bacteriuria; Urinary Tract Infection; Urinary Tract Abnormalities.
- Urinary Tract Infection
- Congenital Abnormality of Kidney and Urinary Tract
- Antibiotic Resistance
- Vesico-ureteric Reflux
- Renal Scar.
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References
Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: A meta-analysis. Paediatr Infect Dis J. 2008;27: 302-08.
Rakhra J, Williams G, Marais BJ, Craig JC, Gunasekera H. Urinary Tract Infection in Febrile Children: Changing spectra of pathogenic bacteria and antibiotic susceptibilities. Journal of Paediatrics and Child Health 2018; 55(6): 680-689. doi:10.1111/jpc.14275.
Tullus K. Fifteen-minute consultation: why and how do children get urinary tract infections? Arch Dis Child Educ Pract Ed 2019. doi:10.1136/archdischild-2018-315023. [Epub ahead of print: 07 Jan 2019].
Subcommittee on Urinary Tract Infection SCoQI, Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.
Stefanidis CJ, Siomou E. Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol. 2007;22(7):937-947.
Lahdes-Vasama T, Niskanen K, Ronnholm K. Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood. Nephrol Dial Transplant. 2006;21(9):2491-2497.
Lee YJ, Lee JH, Park YS. Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study. J Urol. 2012;187(3):1032- 1036.
Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercaptosuccinic acid literature. J Urol. 2009;181(1):290-297; discussion 297-298.
Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am 2006; 53(3): 379-400.
Blumenthal I. Vesicoureteric reflux and urinary tract infection in children. Postgrad Med J 2006; 82(963): 31-5.
Riccabona M. Urinary tract infections in children. Curr Opin Urol 2003; 13(1): 59-62.
Madhi F, Jung C, Timsit S, Levy C, Biscardi S, Lorrot M, et al. (2018) Febrile urinary tract infection due to extended-spectrum betalactamase–producing Enterobacteriaceae in children: A French prospective multicenter study. PLoS ONE 13(1): e0190910. https://doi.org/ 10.1371/journal.pone.0190910).
Harper L, Lefevre Y, Delforge X, Bourquard D, Ferdynus C. Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infection. World Journal of Pediatrics 2019; 15: 204205.
Narasimhan KL, Chowdhary SK, Kaur B, Mittal BR, Bhattacharya A. Factors affecting renal scarring in posterior urethral valves. J Pediatr Urol 2006; 2: 569-74.
Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient paediatric urinary tract infections. J Urol. 2013;190(1):222–27.
Nazme NI, Alamin A, Jalil F, Sultana J, Fatema NN. Bacteriological profile of urinary tract infection in children of a tertiary care hospital. Bangladesh J Child Health 2017; 41 (2): 77- 83.
Paul N, Nusrat N, Islam MR, Rahman F, Rahman N. Clinico-laboratory profile and drug sensitivity pattern in urinary tract infection of children in a tertiary care hospital. Bangladesh J Child Health 2018; 43 (2): 74-79.
Robinson JL, Finlay JC, Lang ME, Bortolussi R. Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health 2014; 19(6): 315-25.
Sedberry-Ross S, Pohl HG. Urinary tract infections in children. Curr Urol Rep 2008; 9(2): 165-71.
Shaikh N, Hoberman A. Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis. In: Post TW, Ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018).
Baumer JH, Jones RW. Urinary tract infection in children, National Institute for Health and Clinical Excellence. Arch Dis Child Educ Pract Ed 2007; 92(6): 189-92.
Jackson MA, Schutze GE; Committee On Infectious Diseases. The use of systemic and topical fluoroquinolones. Pediatrics 2016; 138(5). pii: e20162706.
Palazzi DL, Campbell JR. Acute infectious cystitis: Management and prognosis in children older than two years and adolescents. In: Post TW, ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018)
Ang JY, Ezike E, Asmar BI. Antibacterial resistance. Indian J Pediatr. 2004;71(3):229- 239.
Logan LK. Carbapenem- Resistant Enterobacteriaceae: an emerging problem in children. Healthcare Epidemiology. 2012; 55: 852-859.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 27th informational supplement, CLSI M100-S26. vol. 37 no.1. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
AAP SUBCOMMITTEE ON URINARY TRACT INFECTION. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2–24 Months of Age. Pediatrics. 2016;138(6): e20163026.
Hodson EM, Craig JC. Urinary Tract Infections in Children. In: Paediatric Nephrology, 7th Edition. Ellis D. Avner, William E. Harmon, Patrick Niaude t, Norishige Yoshikawa, Francesco Emma, Stuart l. Goldstein (Editors). Springer- Verlag Berlin Heidelberg, 2016. Pp. 1708-10
McTaggart S, Danchin M, Ditchfield M, Hewitt I, Kausman J, Kennedy S, Trnka P, Williams G. KHA-CARI guideline: Diagnosis and treatment of urinary tract infection in children. Nephrology 2015; 20: 55-60.
Hari P, Srivastava RN. Urinary tract infections. In: Srivastava RN, Bagga A. Pediatric Nephrology. 6th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. 2016. Pp 267-289.
Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014;10: 982–98.
Easterbrook B, Capolicchio J-P, Braga LH. Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: an updated systematic review. Can Urol Assoc J 2017;11(1-2Suppl1):3.).
Wani KA, Ashraf M, Bhat JA, Parry NA, Shaheen L, Bhat SA. Paediatric Urinary Tract Infection: A Hospital Based Experience. Journal of Clinical Diagnostic Research 2016; 10(10): SC 04-07.
Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Paediatrics. 1998;102: e16.
Kalaitzidou I, Ladomenou F, Athanasopoulos E, Antoliotaki M, Vlachaki G. Susceptibility Patterns of Uropathogens Identified in Hospitalized Children. Pediatrics International 2019; 61 (3): 246-251.
Pennesi M, Amoroso S, Bassanese G, Pintaldi S, Giacomini G, Barbi E. Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation. Arch Dis Child 2019; 0:1–4. doi:10.1136/archdischild-2019-317637.
Clark CJ, Kennedy WA II, Shortliffe LD. Urinary tract infection in children: When to worry. Urol Clin North Am 2010; 37(2): 229-41.
Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017; 37(4): 273-9.
Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol 2016; 31(8): 1253-65.
Leung AK. Urinary tract infection. Common problems in ambulatory pediatrics: Specific clinical problems, volume 1. New York: Nova Science Publishers, Inc 2011; pp173-181.
Schlager TA. Urinary tract infections in infants and children. Infect Dis Clin North Am 2003; 17(2): 353-65.
Larcombe J. Urinary tract infection in children: Recurrent infections. BMJ Clin Evid 2015; 2015: 0306.
Shaikh N, Hoberman A. Urinary tract infections in children: Epidemiology and risk factors. In: Post TW, Ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018)
Sedberry-Ross S, Pohl HG. Urinary tract infections in children. Curr Urol Rep 2008; 9(2): 165-71.
Shaikh N, Hoberman A. Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis. In: Post TW, Ed. UpToDate. Waltham, MA. (Accessed on August 10, 2018)
Robson WL, Leung AK. Scarring is the central issue in urinary tract infection, not vesicoureteral reflux. Clin Pediatr (Phila) 2001; 40(5): 302-3.
Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ. Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 2017; 106(1): 149-54.
Mantadakis E, Vouloumanou EK, Panopoulou M, Tsouvala E, Tsalkidis A, Chatzimichael A, Falagas ME. Susceptibility patterns of uropathogens identified in hospitalized children with community-acquired urinary tract infections in Thrace, Greece. J Glob Antimicrob Resist. 2015; 3:85-90.
Spahiu L, Hasbahta V. Most frequent causes of urinary tract infections in children. Med Arh. 2010; 64:88-90.
Abelson Storby K, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12-year analysis. Acta Paediatr. 2004; 93:487–491.
Mantadakis E, Tsalkidis A, Panopoulou M, Pagkalis S, Tripsianis G, Falagas ME, Kartali-Ktenidou S, Chatzimichael A. Antimicrobial susceptibility of pediatric uropathogens in Thrace, Greece. Int Urol Nephrol. 2011; 43:549-55.
Ganesh R, Shrestha D, Bhattachan B, Raj G. Epidemiology of Urinary Tract Infection and Antimicrobial Resistance in a Pediatric Hospital in Nepal. BMC Infectious Disease 2019; 19: 420-424.
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