Antimicrobial misuse in pediatric urinary tract infections: recurrences and renal scarring

Background

In children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care.

Methods

Every inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed.

Results

Frequency of UTI was significantly high among infants (p?=?0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p?=?0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs’ prior to seek treatment from tertiary care pediatric unit (p?=?0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p?=?0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p?=?0.04).

Discussion

Medical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.

     

Retrospective study of children with renal scarring associated with reflux and urinary infection.

OBJECTIVE--To review the histories of children with bilateral renal scarring and severe vesicoureteric reflux to determine whether an improvement in early management might reduce the risk of scarring. DESIGN--Retrospective study of medical records and discussion with parents. SETTING--Outpatient departments of two teaching hospitals. PATIENTS--52 children aged 1-12 years participating in a randomised comparison of medical and surgical management. All had a history of symptomatic urinary tract infection. Two thirds presented with fever and two with hypertension or renal failure. In only one out of 32 children examined by antenatal ultrasonography was an abnormality suspected. RESULTS--There was delay in diagnosis or appropriate imaging or effective treatment of urinary infection in 50 of the 52 children. In 41 there was delay in diagnosis; there was delay in treating a confirmed infection in 45; no antibacterial prophylaxis was prescribed before imaging in 28; and investigation of the urinary tract was delayed in 33. The severity of scarring was significantly related to delay in diagnosis (chi 2 for trend 7.43, P = 0.01). Four children of mothers known to have reflux nephropathy were not investigated until they developed urinary tract infection. CONCLUSIONS--Efforts to reduce the incidence and severity of renal scarring should be directed towards rapid diagnosis and effective early management of urinary tract infection in infancy and childhood. Siblings and offspring of known patients with severe reflux nephropathy should be investigated for reflux.     

Non-secretion of ABO blood group antigens: a host factor predisposing to recurrent urinary tract infections and renal scarring

In a study of 718 women referred for specialist investigation for recurrent urinary tract infections, 250 (34.8%, P less than 0.01) were non-secretors. The proportion of non-secretors among the women with renal scars (42.6%) was higher than that found for women with no evidence of renal scars (36.6%). Among 29 patients in whom symptoms began in childhood or adolescence, 51.7% were non-secretors. The proportion of non-secretors among individuals with renal scars in this study (42.6%) and that reported in the accompanying paper for Swedish children (40%) suggests that non-secretion might influence the pathogenic sequelae of these infections. Possible host-parasite interactions underlying the increased proportion of non-secretors among women with recurrent urinary tract infections and those leading to development of renal scars are discussed.     

Non-secretion of ABO blood group antigens: a host factor predisposing to recurrent urinary tract infections and renal scarring

Abstract In a study of 718 women referred for specialist investigation for recurrent urinary tract infections, 250 (34.8%, P <0.01) were non-secretors. The proportion of non-secretors among the women with renal scars (42.6%) was higher than that found for women with no evidence of renal scars (36.6%). Among 29 patients in whom symptoms began in childhood or adolescence, 51.7% were non-secretors. The proportion of non-secretors among individuals with renal scars in this study (42.6%) and that reported in the accompanying paper for Swedish children (40%) suggests that non-secretion might influence the pathogenic sequelae of these infections. Possible host-parasite interactions underlaying the increased proportion of non-secretors among women with recurrent urinary tract infections and those leading to development of renal scars are discussed.     

Current imaging of childhood urinary infections: prospective survey.

OBJECTIVES--To assess whether ultrasonography alone is adequate for routine screening of childhood urinary infection, whether clinical features determine the need for further investigations, and which investigations are most appropriate. DESIGN--Prospective survey of children with proved urinary infection and a preinvestigation record of clinical features. Ultrasonography and intravenous urography were routine, with choice of further studies determined by ultrasonographic findings. SETTING--A children''s hospital and two district general hospitals in Mersey region. MAIN OUTCOME MEASURES--Sensitivity and specificity of ultrasonography both generally and in relation to clinical features. Accuracy of intravenous urography compared with radioisotope examinations. RESULTS--Specificity of ultrasonography was good (99% (95% confidence interval 96% to 100%)) but sensitivity modest (43% (32% to 55%)), principally with respect to detecting vesicoureteric reflux and renal scarring. Among older children (aged 2-10 years) with positive ultrasound results and fever or vomiting the sensitivity in detecting reflux (with and without renal scarring) was 78% (62% to 89%) and the specificity 69% (60% to 78%); in detecting renal scarring (with and without reflux) the sensitivity was 100% (80% to 100%) and specificity 65% (56% to 74%). Renal scarring and obstructive uropathies were better assessed by radioisotope examinations than by intravenous urography. CONCLUSIONS--Ultrasonography alone is inadequate for routine screening of childhood urinary infection. Though further investigations remain advisable in infants, in older children they can be restricted to a minority who have positive ultrasound examinations or have had fever or vomiting. Radioisotope examinations largely eliminate the need for intravenous urography.     

Psychological aspects of lower urinary tract infections in women.

OBJECTIVE--To determine whether women with the urethral syndrome can be distinguished from those with urinary tract infection by case notes, clinical symptoms, or psychiatric state. DESIGN--Longitudinal survey of consecutive women presenting with dysuria and frequency. SETTING--General practice and community. SUBJECTS--58 patients with the urethral syndrome and 44 patients with a urinary tract infection, mean age 39.9 years. MAIN OUTCOME MEASURES--Results of analysis of serial midstream urine specimens, patients'' self rated physical symptoms and responses to 60 item general health questionnaire at presentation and after resolution of symptoms, and results of psychiatric assessment with the clinical psychiatric interview. RESULTS--4 of 42 patients with a urinary tract infection had recently changed sexual partner compared with none of 58 with the urethral syndrome. Dysuria and nocturia were more common in patients with urinary tract infections than those with the urethral syndrome (mean (SD) score for dysuria 5.37 (2.39) v 4.57 (2.13), p less than 0.05; nocturia in 39/44 (88%) patients v 40/58 (69%), chi 2 = 5.5, p less than 0.02). Both groups showed transient high levels of distress which resolved with the physical symptoms, but no psychiatric difference distinguished them. CONCLUSION--The urethral syndrome is not associated with increased psychiatric morbidity.     

Secretor state and renal scarring in girls with recurrent pyelonephritis

The non-secretor phenotype was significantly associated with the occurrence of renal scarring among patients with recurrent pyelonephritis. Girls (n = 77) with recurrent pyelonephritis were followed from the first known episode of infection for up to twelve years with repeated radiological investigations. They were divided into two categories: those with renal scars (n = 35) and those who did not develop scars (n = 42). There was a significant over-representation of non-secretors among the patients with scarring, (14/35, 40%) compared to the healthy controls (21.8%, P less than 0.05). The frequency of non-secretors among the girls who did not develop scars in spite of repeated episodes of acute pyelonephritis was not significantly different from the healthy controls (9/42, 21% n.s.). This study provides a basis for analysis of the influence of secretor state on host-parasite interaction in the urinary tract.     

Secretor state and renal scarring in girls with recurrent pyelonephritis

Abstract The non-secretor phenotype was significantly associated with the occurrence of renal scarring among patients with recurrent pyelonephritis. Girls ( n = 77) with recurrent pyelonephritis were followed from the first known episode of infection for up to twelve years with repeated radiological investigations. They were divided into two categories: those with renal scars ( n = 35) and those who did not develop scars ( n = 42). There was a significant over-representation of non-secretors among the patients with scarring, (14/35, 40%) compared to the healthy controls (21.8%, P < 0.05). The frequency of non-secretors among the girls who did not develop scars in spite of repeated episodes of acute pyelonephritis was not significantly different from the healthy controls (9/42, 21%, n.s.). This study provides a basis for analysis of the influence of secretor state on host-parasite interaction in the urinary tract.     

Practical management of recurrent urinary tract infections in premenopausal women

Recurrent urinary tract infections (UTIs) are a major healthcare concern for premenopausal, healthy, sexually active women. A practical approach to the management and prevention of recurrent UTIs should be simple, practical, and cost effective. Low-dose or postcoital antimicrobial therapy can be effective for women with constellations of many recurrent UTIs, but for women with 2 to 4 UTIs per year, the most cost-effective and empowering management strategy is patient-initiated antimicrobial treatment.     

Chlamydia trachomatis infections in women with urogenital symptoms.

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician''s office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.     

600例健康体检妇女阴道微生态状况分析

目的研究深圳宝安地区健康妇女阴道微生态状况。方法对2011年9月至2012年2月在深圳宝安区人民医院体检中心进行健康体检的600例妇女阴道分泌物进行检测,检测指标包括清洁度、念珠菌、滴虫、阴道酸碱度、唾液酸苷酶、白细胞酯酶、过氧化氢（H2O2）浓度。结果研究对象中阴道微生态正常328例（54．67％）,微生态失调者272例（45．33％）;阴道微生态失调者中,微生态功能检测阳性率及致病菌的检出率均明显大于微生态正常者,差异有统计学意义（P〈0．05）。结论深圳宝安地区健康体检妇女部分患有阴道炎或存在阴道微生态失调或亚失调状态;阴道微生态联合检测法简便、快速、价廉实用,值得推广。     

Wound healing and scarring after cryosurgery

There are many references in the surgical literature to apparent lack of scarring after cryosurgery. This has been investigated experimentally by comparing the effects on the skin of four freeze-thaw schedules commonly used in clinical practice with those of maximal cryosurgical injury. Absence of damage to collagen is described, and it is proposed that this is an important factor in the often cited lack of scarring. Changes in skin thickness over a 6-month period are described, and obvious scarring after severe injury and long-term dermis thinning after less severe injury are reported. Evidence is presented that epidermal cells and fibroblasts differ in their susceptibility to low-temperature damage.