19.01.2014

Trying for a baby urine infection

Clinical and demographic factors associated with urinary tract infection in young febrile infants. Metaanalysis of urine screening tests for determining the risk of urinary tract infection in children Pediatr Infect Dis J. Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Short-course versus conventional length antimicrobial therapy for uncomplicated lower urinary tract infections in children: a meta-analysis of 1279 patients. A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children.
Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study.
Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood.
Pathogenesis of urinary tract infection—experimental studies of vaginal resistance to colonization.
Urinary tract infections in girls: the cost-effectiveness of currently recommended investigative routines.
The most common pathogen is Escherichia coli, accounting for approximately 85 percent of urinary tract infections in children.
The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females. Recent treatment of an upper respiratory infection with amoxicillin or a cephalosporin may indicate the need to try to avoid prescribing these agents for the child in the future. The literature describing various protocols for the imaging evaluation of the urinary tract following a UTI is extensive.
Renal parenchymal defects are present in 3 to 15 percent of children within one to two years of their first diagnosed urinary tract infection. In infants and young children, typical signs and symptoms include fever, strong-smelling urine, hematuria, abdominal or flank pain, and new-onset urinary incontinence.


Evidence-based care guideline for medical management of first urinary tract infection in children 12 years of age or less. An important risk factor for UTIs in girls is antibiotic therapy, which disrupts the normal periurethral flora and fosters the growth of uropathogenic bacteria. However, if amoxicillin or a cephalosporin is required for treatment of an upper respiratory infection, it is important not to discontinue therapy with nitrofurantoin (Macrodantin) or trimethoprim-sulfamethoxazole (Bactrim, Septra) in the child who is receiving suppressive antimicrobial therapy to prevent recurrent UTIs. Unfortunately, no prospective studies with long-term outcome data are available.21 Some experts recommend that all children with a UTI be investigated with urinary tract ultrasonography. Clinical signs and symptoms of a urinary tract infection depend on the age of the child, but all febrile children two to 24 months of age with no obvious cause of infection should be evaluated for urinary tract infection (with the exception of circumcised boys older than 12 months).
A bagged specimen of urine that shows no growth or fewer than 10,000 colony-forming units (CFU) per mL is evidence of the absence of a UTI. Currently, the most effective intervention for preventing recurrent UTIs in children is the identification and treatment of voiding dysfunction. If the child who has not yet achieved urinary control has symptoms that mandate immediate treatment, and analysis of the urine specimen obtained by bag shows pyuria, or tests for positive nitrite or bacteriuria, a urine sample should be obtained by suprapubic aspiration or catheter before starting antibiotic therapy because of the high incidence of false-positive bagged urine cultures.Treatment of acute pyelonephritis or cystitis may be initiated based on the urinalysis findings. Imaging evaluation of the urinary tract following a UTI should be individualized, based on the child's clinical presentation and on clinical judgment.
Fluoroquinolones may be useful when infection is caused by multidrug-resistant pathogens for which there is no safe and effective alternative, parenteral therapy is not feasible, and no other effective oral agent is available. Both bladder and upper urinary tract imaging with ultrasonography and a voiding cystourethrogram should be obtained in an infant or child with acute pyelonephritis. Older children with cystitis usually present with any or all of the following: urinary urgency, frequency, hesitancy, dysuria and, at times, incontinence. Imaging studies may not be required, however, in older children with cystitis who respond promptly to treatment.Urinary tract infections (UTIs) are common in children. The goal is to eliminate the episodes of urinary urgency, during which there may be reflux of bacteria-laden urine from the distal urethra into the urinary bladder. If vesicoureteral reflux is present, long-term suppressive antibiotic therapy may be indicated.30 Some clinicians recommend six months of suppressive antibiotic therapy for children who have pyelonephritis in the absence of vesicoureteral reflux (nonrefluxing pyelonephritis). Prophylactic antibiotics do not reduce the risk of subsequent urinary tract infections, even in children with mild to moderate vesicoureteral reflux.
The infant receives specific protection against infection from these bacteria through immunoglobulins transferred from the mother during gestation and after delivery in the mother's breast milk.In contrast, babies born and cared for in a hospital are likely to be colonized by strains acquired from the external environment, against which their mothers may have no immunity. Anticholinergic agents not only alter bladder function but also suppress intestinal motility, so attention to constipation must be ongoing.UTI Prevention MythsSome forms of intervention to prevent recurrent UTIs in children, mainly young girls, appear to be based more on myth than on substance.
Dipstick tests for blood and protein have poor sensitivity and specificity in the detection of UTI and may be misleading. The usual approach in children is to first treat the infection and then obtain imaging studies of the urinary tract.


Ultrasonography, cystography, and a renal cortical scan should be considered in children with urinary tract infections.Guidelines regarding the diagnosis, treatment, and follow-up of urinary tract infections (UTIs) in children continue to evolve. For aesthetic reasons, it seems appropriate to instruct girls to wipe from front to back, but no data indicate that this practice prevents vaginal and vulval colonization with Enterobacteriaceae.16 According to Kunin,17 the commonly held view that UTIs in women are caused by fecal contamination of the periuretheral zone is unproved. A good rule is that urine should be evaluated for the presence of infection in the infant or young child who has an unexplained fever for as long as three days. Although a somewhat less aggressive approach to evaluation is now recommended, it is important for primary care physicians to appropriately diagnose and treat UTIs in children. The National Institute for Health and Clinical Excellence in the United Kingdom endorses incorporating specific strategies for urine testing based on the child's age (Figure 1).15 In this model, microscopy and urine culture should be performed in children younger than three years instead of dipstick testing. Colonization of the prepuce by these potentially dangerous bacteria places the uncircumcised male at high risk for a UTI. Acute pyelonephritis may be diagnosed in the older child with fever, systemic symptoms, costovertebral angle or flank tenderness and urinary findings suggestive of a UTI.Asymptomatic BacteriuriaChildren, usually school-aged girls, with significant bacteriuria in the absence of any symptoms do not require further evaluation of the urinary tract or treatment. Radionuclide cystography or voiding cystourethrography is effective for screening and grading vesicoureteral reflux, but involves radiation exposure and catheterization. Although voiding cystourethrography is suggested for either girls or boys, radionuclide cystography is suggested only for girls because voiding cystourethrography is needed for adequate anatomic imaging of the urethra and bladder in boys.
A renal cortical scan (also called scintigraphy or DMSA scan) uses technetium and is effective for assessing renal scarring, but requires intravenous injection of radioisotope.Long-term outcome studies have not been performed to determine the best initial imaging study in children diagnosed with UTI. Symptoms of voiding dysfunction may be secondary to a UTI or to local irritants such as pinworm infestation or bubble bath, or hypercalciuria.In the anatomically and neurologically normal child, voiding dysfunction is usually caused by persistence of an unstable urinary bladder, an important contributor to recurrent UTIs. An unstable urinary bladder is a common functional disorder and usually has been present since daytime urinary control was first developing in the child. The presumed antibacterial effects of cranberry juice are controversial, attributed by some to urinary acidification and by others to a direct bacteriostatic effect of hippuric acid on E. The outstanding characteristic is persistent urinary urgency.Recognition and management of voiding dysfunction is the area in which the physician can be most effective in the prevention of recurrent UTIs.
A girl with voiding dysfunction is at increased risk for recurrent UTIs because of reflux of urine laden with bacteria from the distal urethra into the bladder.13 Studies have demonstrated that reflux of contrast material from the distal urethra into the bladder occurs when continence is maintained by contraction or compression of the bladder outlet rather than by the normal neurogenic inhibition of the detrusor contraction. When urinary leakage is prevented by compression of the urethral sphincter during an uninhibited contraction, the flat bladder base becomes funnel shaped and the posterior urethra is filled with urine.
Shortly thereafter, when the contraction subsides, bacterialaden urine from the urethra may reflux back into the bladder.



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