Abstract
Introduction: Urinary tract infection (UTI) is a very common infection in childhood, which sometimes indicates functional or structural dysfunction in urinary tracts. If UTI is not treated properly, it may damage kidney. UTI is still one of the most common causes of chronic renal insuffi ciency in our country. The aim of this study was to investigate retrospectively the demographic, clinical and laboratory features, and prognosis of 472 patients with UTI followed up in our Pediatric Nephrology clinic. Patients and Methods: The gender, age, symptoms, microorganisms grown in urine culture, antibiotic sensitivities, anatomic and functional abnormalities of urinary tract, and therapies given to the patients were retrospectively evaluated to determine the roles of these parameters on the development of renal damage.Results: Among 472 patients, 368 (78%) were female and 104 (22%) were male. Of these 104 male patients, 74% were below 2 years old. Symptoms of UTI were different in various age groups. While 108 patients had only one UTI, 364 had recurrent UTI. Among all patients with UTI, 170 had risk factors of anatomic or functional urinary system abnormalities for UTI development. When these patients with risk factors and patients without risk factors were compared, the risk of UTI recurrence was not statistically signifi cant (p>0.05). The most common identifi ed microorganism was E.coli ESBL(-) and most of them (90%) were sensitive to amikacin, gentamicin, netilmicin, cefepim, ceftriaxone, ceftazidime, aztreonam and imipenem. Number of UTI recurrence showed a statistically signifi cant effect on development of renal damage (p<0.05). But there was no statistically signifi cant relationship between degree of VUR and development of renal damage (p>0.05).Conclusion: The patients diagnosed as UTI should be investigated for urinary tract abnormalities by imaging tecniques and the ampirical antibiotics should be started to these patients according to the local antibiotic susceptibilities. As a result, early diagnosis and treatment of UTI and urinary tract abnormalities were very important for protection of the patient from long term sequelas of UTI
Keywords
References
- Zelikovic I, Adelman RD, Nancarrow PA. Urinary tract infecti- ons in children. West J Med. 1992;157:554-561
- National Institute for Health and Clinical Excellence (NICE). Urinary tract infection in children. (http://guidance.nice.org.uk/ CG054) 2007.
- Leonardo C.R., Filgueiras M.F.T, Vasconcelos M.M., Vasconcelos R., Marino V.P., Pires C., Pereira A.C..Risk factors for renal scar- ring in children and adolescents with lower urinary tract dysfunc- tion. Pediatr Nephrol. 2007; 22:1891–1896
- Taneja N, Chatterjee SS, Singh M, Singh S, Sharma M.. Pediatric urinary tract infections in a tertiary care center from north India. Indian J Med Res. 2010;131:101-105.
- Mathews R, Mattoo TK. Comprehensive Pediaric Nepfrology first edition.Mosby., pp. 549-559
- Brakeman P.Vesicoureteral reflux, reflux nephropathy and end- stage renal disease. Adv Urol. 2008:508949.
- Jakobsson B, Berg U, Svensson L. Renal scarring after acute pye- lonephritis. Arch Dis Child. 1994;70:111-115.
- Ditchfield MR, Grimwood K, Cook DJ, Powell HR, Sloane R,Gulati S, de Campo JF (2004) Persistent renal cortical scin- tigram defects in children 2 years after urinary tract infection. Pediatr Radiol 34:465–471
- Smellie JM, Barratt TM, Chantler C, et al. Medical versus sur- gical treatment in children with severe bilateral vesicourete- ric reflux and bilateral nephtopathy: a randomised trial. Lancet 2001;357:1329-1333
- Weiss R, Duckett J, Spitzer A. Results of a randomised clinical trial of medical versus surgical treatment of infants and child- ren with grade III and IV primary vesicoureteral reflux: the International Reflux Study in Children. J Urol 1992;148:1667- 1673
Abstract
Giriş ve Amaç: İdrar yolu enfeksiyonu (İYE), çocukluk çağında sık görülen bir enfeksiyon olup üriner sistemin fonksiyonel veya yapısal bozukluğunun bir göstergesi olabilir. İYE doğru tedavi edilmediği zaman kalıcı renal hasar ile sonuçlanabilmektedir. Ülkemizde kronik böbrek yetmezliği nedenleri içerisinde İYE ilk sırayı almaktadır. Bu çalışmada, Pediatrik Nefroloji Kliniğimizde İYE tanısı ile izlenen 472 hasta retrospektif incelenerek hastaların demografi k, klinik ve laboratuvar özellikleri ve prognozları değerlendirilmiştir. Olgular ve Yöntemler: Çalışmaya alınan hastalar, cinsiyet, yaş, semptom ve bulgular, idrar kültüründe üreyen mikroorganizmalar ve antibiyotik duyarlılıkları, altta yatan anatomik veya fonksiyonel üriner sistem anormallikleri, uygulanan tedaviler ve tüm bu faktörler ile renal skar gelişimi arasındaki ilişki açısından retrospektif olarak değerlendirilmiştir. Bulgular: Toplam 472 hastanın 368’i (%78) kız ve 104’ü (%22) erkek olup erkek hastaların %74’ü 2 yaşın altındaydı. İYE semptomları yaşa göre farklılık göstermekteydi. Hastaların 108’inde tek İYE, 364’ünde tekrarlayan İYE mevcuttu. Hastaların 170’inde anatomik veya fonksiyonel üriner sistem anormalliği saptanırken risk faktörü olanlarla olmayanlar arasında İYE tekrarlaması açısından istatistiksel farklılık yoktu. Hastalarımızın idrar kültürlerinde en sık tespit edilen mikroorganizma E.coli ESBL(-) olup >%90 oranda amikasin, gentamisin, netilmisin, sefepim, seftriakson, seftazidim, aztreonam ve imipenem duyarlı bulundu. İYE geçirme sayısının skar gelişimi üzerine etkisi istatistiksel açıdan anlamlıydı. Vezikoüreteral refl ü derecesi ile skar gelişimi arasında istatistiksel anlamlı fark bulunmadı. Sonuç: İYE tanısı alan hastalar, üriner sistem anormalliği açısından, görüntüleme yöntemleri ile incelenmeli ve hastaya ampirik tedavi başlanırken lokal antibiyotik direnç verileri göz önünde bulundurulmalıdır. İYE ve altta yatan üriner sistem anormalliklerinin erken tanı ve uygun tedavisi İYE’nin uzun dönem sekellerini önlemede önemlidir.
Keywords
References
- Zelikovic I, Adelman RD, Nancarrow PA. Urinary tract infecti- ons in children. West J Med. 1992;157:554-561
- National Institute for Health and Clinical Excellence (NICE). Urinary tract infection in children. (http://guidance.nice.org.uk/ CG054) 2007.
- Leonardo C.R., Filgueiras M.F.T, Vasconcelos M.M., Vasconcelos R., Marino V.P., Pires C., Pereira A.C..Risk factors for renal scar- ring in children and adolescents with lower urinary tract dysfunc- tion. Pediatr Nephrol. 2007; 22:1891–1896
- Taneja N, Chatterjee SS, Singh M, Singh S, Sharma M.. Pediatric urinary tract infections in a tertiary care center from north India. Indian J Med Res. 2010;131:101-105.
- Mathews R, Mattoo TK. Comprehensive Pediaric Nepfrology first edition.Mosby., pp. 549-559
- Brakeman P.Vesicoureteral reflux, reflux nephropathy and end- stage renal disease. Adv Urol. 2008:508949.
- Jakobsson B, Berg U, Svensson L. Renal scarring after acute pye- lonephritis. Arch Dis Child. 1994;70:111-115.
- Ditchfield MR, Grimwood K, Cook DJ, Powell HR, Sloane R,Gulati S, de Campo JF (2004) Persistent renal cortical scin- tigram defects in children 2 years after urinary tract infection. Pediatr Radiol 34:465–471
- Smellie JM, Barratt TM, Chantler C, et al. Medical versus sur- gical treatment in children with severe bilateral vesicourete- ric reflux and bilateral nephtopathy: a randomised trial. Lancet 2001;357:1329-1333
- Weiss R, Duckett J, Spitzer A. Results of a randomised clinical trial of medical versus surgical treatment of infants and child- ren with grade III and IV primary vesicoureteral reflux: the International Reflux Study in Children. J Urol 1992;148:1667- 1673
Details
| Other ID | JA99TV36DJ |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 1, 2010 |
| Submission Date | April 1, 2010 |
| Published in Issue | Year 2010 Volume: 4 Issue: 4 |
The publication language of Turkish Journal of Pediatric Disease is English.
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