Abstract
Abstract
One of the most common causes of childhood infections is urinary tract infecti-on (UTI). Permanent renal damage is seen in 15% of patients and hypertension, proteinuria or chronic renal disease are among the long-term sequelae of UTI. Escherichia coliis the most important bacterial cause of UTI, and responsible for 70-80%of infections. The development and severity of the disease is related to multiple factors such as bacterial virulence, immune system, the presence of urinary obstruction, bladder and bowel dysfunctions, vesicoureteral reflux, and bladder catheterizations. In urinary tract infection, the diagnosis is made by physical examination of thepatient, complete urine analysis and urine culture. Early and effective antibiotic treatment is important to prevent renal damage. The antibiotic selection depends on patient age, underlying medical and urological problems, and antibiotic resistance in that area. The goal for further investigation is to find outwhether there is a urinary obstruction, vesicoureteral reflux or renal damage. Ultrasonography can identify abnormalities in the upper and lower urinary system. Renal scintigraphy is useful for the detection of renal parenchymaldamage, and voiding cystourethrography is used for detection of vesicoureteral reflux. Multidisciplinary workupincluding pediatrician, pediatric nephrologist and urolo-gist is important in the follow-up of children who require further investigation.
References
- Kaynaklar 1.Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, El-lis D. Prevalence of urinary tract infection in febrile infants.J Pediatr 1993 123: 17–23. 2.Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of uri-nary tract infection in childhood: a meta-analysis. Pediatr In-fect Dis J 2008 27: 302–308. 3.Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U. As-sociation between urinary symptoms at 7 years old and pre-vious urinary tract infection. Arch Dis Child 1991; 66:232–34. 4.Marild S, Jodal U. Incidence rate of first-time symptomaticurinary tract infection in children under 6 years of age. ActaPaediatr 1998; 87: 549–52. 5.Kliegman RM, Stanton BF, St Geme JW, Schor NF, BehrmanRE, eds. Nelson Textbook of Pediatrics, 20th ed. Philadelp-hia: Elsevier, 2016. 6.Biyikli NK, Alpay H, Ozek E, Akman I, Bilgen H. Neonatal uri-nary tract infections: Analysis of the patients and reccuren-ces. Pediatr Int 2004; 46: 21-25. 7.Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resis-tance patterns of outpatient pediatric urinary tract infections.J Urol 2013; 190: 222-27. 8.Shaikh N, Craig JC, Rovers MM, et al. Identification of child-ren and adolescents at risk for renal scarring after first uri-nary tract infection: a meta-analysis with individual patientdata. JAMA Pediatr 2014; 168: 893. 9.Kauffman CA, Vazquez JA, Sobel JD, al. Prospective multi-center surveillance study of funguria in hospitalized patients.The national Institute for Allergy and Infectious Diseases (NI-AID) Mycoses Study Group. Clin Infect Dis 2000; 30: 44. 10.Schlager TA, Whittam TS, Hendley JO, et al. Comparison ofexpression of virulance factors by Escherichia coli causingcystitis and E coli colonizing the periurethra of healthy girls.J Infect Dis 1995; 172: 772. 11.Svanborg C, Frendéus B, Godaly G, Hang L, Hedlund M,Wachtler C. Toll-like receptor signaling and chemokine re-ceptor expression influence the severity of urinary tract infec-tion. J Infect Dis 2001; 183: S61ç 12.Gokce I, Alpay H, Biyikli N, Unluguzel G, Dede F, Topuzog-lu A. Urinary levels of interleukin-6 and interleukin-8 in pa-tients with vesicoureteral reflux and renal parenchymalscar. Pediatr Nephrol 2010; 25: 905-12. 13.Kirmusaoglu S, Yurdugül S, Metin A, Vehid S. The effect ofurinary catheters on microbial biofilms and catheter associated urinary tract infections. Urol J. 2017; 14: 3028-34. 14.Lellig E, Apfelbeck M, Straub J, et al. Harwegsinfekte bei Kin-dern Urologe 2017; 56: 247-62. 15.Tosif S, Baker A, Oakley E, Donath S, Babl FE. Contaminati-on rates of different urine collection methods for the diagno-sis of urinary tract infections in young children: an observa-tional cohort study. Paediatr Child Health 2012; 48: 659-64. 16.Reaffirmation of AAP clinical practice guideline (2016): Thediagnosis and management of the initial urinary tract infec-tion in febrile infants and young children 2-24 months of age.Pediatrics 2016; 138: e3026. 17.Clinical practice guideline. Urinary tract infection: clinicalpractice guideline for the diagnosis and management of theinitial UTI in febrile infants and children 2 to 24 months. Pe-diatrics 2011; 128: 595-610. 18.Stein R, Dogan HS, Hoebeke P, et al Urinary tract infections inchildren: EAU/ESPU Guidelines Eur Urol 2015; 67: 546-58. 19.National Institute for Health and Care Excellence. Urinarytract infection in children. 2011. 20.Gökçe İ, Çiçek N, Güven S, et al. Changes in bacterial resis-tance patterns of pediatric urinary tract infections in İstan-bul and rationale for empirical antibiotic therapy doi:10.4274/balkanmedj.2015.1809. 21.Craig JC, Simpson JM, Williams GJ, et al Antibiotic prophy-laxis and recurrent urinary tract infection in children. N EnglJ Med 2009; 361: 1748-59. 22.The RIVUR Trial Investigators Antibiotic prophylaxis forchildren with vesicoureteral reflux. N Engl J Med 2014; 370:2367-76. 23.Williams G, Craig JC Long term antibiotics for preventing re-current urinary tract infection in children. Cochrane Data-base Syst 2011 Mar 16 (3). 24.Morris BJ, Wiswell TE. Circumcision and lifetime risk of uri-nary tract infection: a systematic review and meta-analysis.J Urol 2013; 189: 2118-24. 25.Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Pro-biotics feeding in prevention of urinary tract infection, bac-terial sepsis and necrotizing enterocolitis in preterm infants.A prospective double – blind study. Biol Neonate 2002; 82:103-108.
Abstract
Öz
Çocukluk çağı enfeksiyonlarının en sık nedenlerinden biri idrar yolu enfeksiyonudur (İYE). Kalıcı böbrek hasarı hastaların %15’inde görülür ve hipertansiyon, pro-teinüri veya kronik böbrek hastalığı uzun dönem sekelleridir. Escherichia coliİ YE’ninen önemli bakteriyel sebebi olup, enfeksiyonların %70-80’inden sorumludur. İYE mgelişiminde ve hastalığın şiddetinde bakteriyel virulans faktörleri, konağın bağışıklık sistemi, üriner obstrüksiyon varlığı, mesane ve barsak disfonksiyonları, vezikoüretral reflü ve mesane kateterizasyonları etkilidir.İdrar yolu enfeksiyonunda tanı, hastanın fizik muayene bulguları, tam idrar tahlili ve idrar kültürü ile konur. Renal hasarı önlemede erken ve etkili antibiyotik başlanması önemlidir. Antibiyotik seçimini, hasta yaşı, altta yatan medikal ve ürolojik problemler ve o bölgedeki antibiyotik direnci etkiler. İdrar yolu enfeksiyonu geçiren çocukta incelemenin amacı varsa obstrüksiyonu, reflüyü ve hasarı ortaya koymaktır. Üst ve alt üriner sistemdeki anomalileri göstermede ultrasonografi, renal parankim hasarını saptamada renal sintigrafi, vezikoüreteral reflünün ortaya konmasında voiding sistoüreterografi kullanılır. İleri inceleme gerektiren çocukların izleminde pediatrist, pediatrik nefrolog ve ürolog iş birliği önemlidir.
References
- Kaynaklar 1.Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, El-lis D. Prevalence of urinary tract infection in febrile infants.J Pediatr 1993 123: 17–23. 2.Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of uri-nary tract infection in childhood: a meta-analysis. Pediatr In-fect Dis J 2008 27: 302–308. 3.Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U. As-sociation between urinary symptoms at 7 years old and pre-vious urinary tract infection. Arch Dis Child 1991; 66:232–34. 4.Marild S, Jodal U. Incidence rate of first-time symptomaticurinary tract infection in children under 6 years of age. ActaPaediatr 1998; 87: 549–52. 5.Kliegman RM, Stanton BF, St Geme JW, Schor NF, BehrmanRE, eds. Nelson Textbook of Pediatrics, 20th ed. Philadelp-hia: Elsevier, 2016. 6.Biyikli NK, Alpay H, Ozek E, Akman I, Bilgen H. Neonatal uri-nary tract infections: Analysis of the patients and reccuren-ces. Pediatr Int 2004; 46: 21-25. 7.Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resis-tance patterns of outpatient pediatric urinary tract infections.J Urol 2013; 190: 222-27. 8.Shaikh N, Craig JC, Rovers MM, et al. Identification of child-ren and adolescents at risk for renal scarring after first uri-nary tract infection: a meta-analysis with individual patientdata. JAMA Pediatr 2014; 168: 893. 9.Kauffman CA, Vazquez JA, Sobel JD, al. Prospective multi-center surveillance study of funguria in hospitalized patients.The national Institute for Allergy and Infectious Diseases (NI-AID) Mycoses Study Group. Clin Infect Dis 2000; 30: 44. 10.Schlager TA, Whittam TS, Hendley JO, et al. Comparison ofexpression of virulance factors by Escherichia coli causingcystitis and E coli colonizing the periurethra of healthy girls.J Infect Dis 1995; 172: 772. 11.Svanborg C, Frendéus B, Godaly G, Hang L, Hedlund M,Wachtler C. Toll-like receptor signaling and chemokine re-ceptor expression influence the severity of urinary tract infec-tion. J Infect Dis 2001; 183: S61ç 12.Gokce I, Alpay H, Biyikli N, Unluguzel G, Dede F, Topuzog-lu A. Urinary levels of interleukin-6 and interleukin-8 in pa-tients with vesicoureteral reflux and renal parenchymalscar. Pediatr Nephrol 2010; 25: 905-12. 13.Kirmusaoglu S, Yurdugül S, Metin A, Vehid S. The effect ofurinary catheters on microbial biofilms and catheter associated urinary tract infections. Urol J. 2017; 14: 3028-34. 14.Lellig E, Apfelbeck M, Straub J, et al. Harwegsinfekte bei Kin-dern Urologe 2017; 56: 247-62. 15.Tosif S, Baker A, Oakley E, Donath S, Babl FE. Contaminati-on rates of different urine collection methods for the diagno-sis of urinary tract infections in young children: an observa-tional cohort study. Paediatr Child Health 2012; 48: 659-64. 16.Reaffirmation of AAP clinical practice guideline (2016): Thediagnosis and management of the initial urinary tract infec-tion in febrile infants and young children 2-24 months of age.Pediatrics 2016; 138: e3026. 17.Clinical practice guideline. Urinary tract infection: clinicalpractice guideline for the diagnosis and management of theinitial UTI in febrile infants and children 2 to 24 months. Pe-diatrics 2011; 128: 595-610. 18.Stein R, Dogan HS, Hoebeke P, et al Urinary tract infections inchildren: EAU/ESPU Guidelines Eur Urol 2015; 67: 546-58. 19.National Institute for Health and Care Excellence. Urinarytract infection in children. 2011. 20.Gökçe İ, Çiçek N, Güven S, et al. Changes in bacterial resis-tance patterns of pediatric urinary tract infections in İstan-bul and rationale for empirical antibiotic therapy doi:10.4274/balkanmedj.2015.1809. 21.Craig JC, Simpson JM, Williams GJ, et al Antibiotic prophy-laxis and recurrent urinary tract infection in children. N EnglJ Med 2009; 361: 1748-59. 22.The RIVUR Trial Investigators Antibiotic prophylaxis forchildren with vesicoureteral reflux. N Engl J Med 2014; 370:2367-76. 23.Williams G, Craig JC Long term antibiotics for preventing re-current urinary tract infection in children. Cochrane Data-base Syst 2011 Mar 16 (3). 24.Morris BJ, Wiswell TE. Circumcision and lifetime risk of uri-nary tract infection: a systematic review and meta-analysis.J Urol 2013; 189: 2118-24. 25.Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Pro-biotics feeding in prevention of urinary tract infection, bac-terial sepsis and necrotizing enterocolitis in preterm infants.A prospective double – blind study. Biol Neonate 2002; 82:103-108.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | makale |
| Authors | |
| Publication Date | September 10, 2017 |
| Published in Issue | Year 2017 Volume: 9 Issue: 5 |
