Microbial inflammatory diseases of the urinary system in children
Keywords:
microbial-inflammatory diseases, urinary system, childrenAbstract
The article is the result of a compilation of modern domestic and foreign sources regarding the determining aspects of microbial-inflammatory diseases of the urinary tract in children: prevalence, etiology, pathogenesis, diagnostic and therapeutic algorithms, their level of evidence. Attention is also drawn to the issues of prevention of recurrent urinary tract infection (UTI), rehabilitation and clinical examination of patients. It is noted that UTI is quite common in childhood: 8% of girls and 2% of boys have at least one episode by the age of seven. Peak age is Bimodal, one peak at infancy and the other peak from 2 to 4 years (at the time of toilet training). The most common pathogen is E. coli, which is approximately 85% in the structure of uropathogens of all age groups of children. The clinical signs and symptoms of UTIs depend on the age of the child, but all children with an unclear fever between the ages of 2 and 24 months should be evaluated for UTIs. Assessment of older children may depend on the clinical picture and laboratory symptoms. For example, positive leukocyte esterase and/or nitrite test according to the dipstick test; pyuria of at least 10 leukocytes in the field of view under microscopy and bacteriuria in culture. Physiological mechanisms that counteract the UTI include acidity and free passage of urine, timely emptying of the bladder, intact urogenital and urethral sphincters, as well as complete immunological and mucosal barriers. The abnormality of any of these mechanisms shapes the predisposition to UTI. Renal parenchymal defects are diagnosed in 3–15% of children within one to two years of the first diagnosed UTI. Recently, most authors think that parenchymal scarring due to coronary artery disease occurs in patients with renal dysplasia and with a background of Vesicoureteric Reflux (VUR). The increased rate of E. coli resistance formation has made amoxicillin unacceptable for the empirical treatment of UTI in most children. So the drugs of choice today are cephalosporins and nitrofuran for the lower parts of the urological tract. Preventive courses of antibiotics do not reduce the risk of subsequent episodes of UTI, even in children with mild and moderate VUR.References
Pyrih LA, Ivanov DD, Kushnirenko SV. (2011). Stupinchata terapiia piielonefrytu. Inf. lyst MOZ Ukrainy z problemy Pediatriia. 2;246.
Anderson GG et al. (2003). Intracellular bacterial biofilm0like pods in urinary tract infections.Science.301: 105–107. https://doi.org/10.1126/science.1084550; PMid:12843396
Bishop BL et al. (2007). Cyclic AMP-regulated exocytosis of Escherichia coli from infected bladder epithelial cells. Nat Med.13: 625–630. https://doi.org/10.1038/nm1572; PMid:17417648
Chen SL et al. (2013). Genomic diversity and fitness of E. coli strains recovered from the intestinal and urinary tracts of women with recurrent urinary tract infection. Sci Transl Med. 5: 184ra160. https://doi.org/10.1126/scitranslmed.3005497; PMid:23658245 PMCid:PMC3695744
Cyriac J, Holden K, Tullus K. (2017). How to use urine dipsticks. Arch Dis Child Educ Pract Ed.102: 148–54. https://doi.org/10.1136/archdischild-2015-309083; PMid:27836919
Edlin RS, Shapiro DJ, Hersh AL et al. (2013). Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol.190: 222–7. https://doi.org/10.1016/j.juro.2013.01.069; PMid:23369720 PMCid:PMC4165642
Fritzenwanker M, Imirzalioglu C, Chakraborty T et al. (2016). Modern diagnostic methods for urinary tract infections.Expert Rev Anti Infect Ther.14: 1047–63. https://doi.org/10.1080/14787210.2016.1236685; PMid:27624932
Greenhow TL, Hung Y0Y, Herz AM et al. (2014). The changing epidemiology of serious bacterial infections in young infants. Pediatr Infect Dis J. 33: 595–9. https://doi.org/10.1097/INF.0000000000000225; PMid:24326416
Guidelines on the Management Urinary and Mail Genital Tract Infections European Association of Urology (2008, March): 116.
Guidelines on the Management Urinary Tract Infections European Association of Urology. (2018, March).
Hannan TJ et al. (2012). Host-pathogen checkpoints and population bottlenecks in persistent and intracellular uropathogenic Escherichia coli bladder infection. FEMS Microbiol Rev.36: 616–648. https://doi.org/10.1111/j.1574-6976.2012.00339.x; PMid:22404313 PMCid:PMC3675774
Hewitt IK, Pennesi M, Morello W et al. (2017). Antibiotic prophylaxis for urinary tract infection-related renal scarring: a systematic review. Pediatrics.139: e20163145. https://doi.org/10.1542/peds.2016-3145; PMid:28557737
Hoberman A, Greenfield SP, Mattoo TK et al. (2014). Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 370: 2367–76. https://doi.org/10.1056/NEJMoa1401811; PMid:24795142 PMCid:PMC4137319
Justice SS et al. (2004). Differentiation and developmental pathways of uropathogenic Escherichia coli in urinary tract pathogenesis. Proc Natl Acad Sci USA.101: 1333–1338. https://doi.org/10.1073/pnas.0308125100; PMCid:PMC337053
Kaufman J, Knight AJ, Bryant PA et al. (2019). Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children.Arch Dis Child. https://doi.org/10.1136/archdischild-2019-317561; PMid:31444211
Keren R, Shaikh N, Pohl H et al. (2015). Risk factors for recurrent urinary tract infection and renal scarring.Pediatrics.136: e13–21. https://doi.org/10.1542/peds.2015-0409; PMid:26055855 PMCid:PMC4485012
Miao Y et al. (2015). A TRP channel senses lysosome neutralization by pathogens to trigger their expulsion.Cell.161: 1306–1319. https://doi.org/10.1016/j.cell.2015.05.009; PMid:26027738 PMCid:PMC4458218
Miao Y et al. (2016). Ubiquitination of innate immune regulator TRAF3 orchestrates expulsion of intracellular bacteria by exocyst complex. Immunity.45: 94–105. https://doi.org/10.1016/j.immuni.2016.06.023
Mulvey MA et al. (2001). Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection. Infect Immun.69: 4572–4579. https://doi.org/10.1128/IAI.69.7.4572-4579.2001; PMid:11402001 PMCid:PMC98534
Mysorekar IU, Hultgren SJ. (2006). Mechanisms of uropathogenic Escherichia colipersistence and eradication from the urinary tract. Proc Natl Acad Sci USA.103: 14170–14175. https://doi.org/10.1073/pnas.0602136103; PMid:16968784 PMCid:PMC1564066
NICE Resource impact report: Urinary tract infection in under 16s: diagnosis and management (CG54): National Institute for Health and Care Excellence. 2018
O'Brien K, Edwards A, Hood K et al. (2013). Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling. Br J Gen Pract. 63: e156–64. https://doi.org/10.3399/bjgp13X663127; PMid:23561695 PMCid:PMC3553642
Okarska-Napierala M, Wasilewska A, Kuchar E. (2017). Urinary tract infection in children: Diagnosis, treatment, imaging – Comparison of current guidelines. J Pediatr Urol.13: 567–73. https://doi.org/10.1016/j.jpurol.2017.07.018; PMid:28986090
Robino L et al. (2014). Intracellular bacteria in the pathogenesis of Escherichia coliurinary tract infection in children.Clin Infect Dis.59: e158–e164. https://doi.org/10.1093/cid/ciu634; PMid:25091303 PMCid:PMC4650771
Rosen DA et al. (2007). Detection of intracellular bacterial communities in human urinary tract infection.PLoS Med.4: e329. https://doi.org/10.1371/journal.pmed.0040329; PMid:18092884 PMCid:PMC2140087
Salo J, Ikaheimo R, Tapiainen T et al. (2011). Childhood urinary tract infections as a cause of chronic kidney disease. Pediatrics. 128: 840–7. https://doi.org/10.1542/peds.2010-3520; PMid:21987701
Schilling JD et al. (2002). Effect of trimethoprim-sulfamethoxazole on recurrent bacteriuria and bacterial persistence in mice infected with uropathogenic Escherichia coli. Infect Immun. 70: 7042–7049. https://doi.org/10.1128/IAI.70.12.7042-7049.2002; PMid:12438384 PMCid:PMC132990
Schwartz DJ et al. (2011). Population dynamics and niche distribution of uropathogenic Escherichia coli during acute and chronic urinary tract infection. Infect Immun.79: 4250–4259. https://doi.org/10.1128/IAI.05339-11; PMid:21807904 PMCid:PMC3187256
Shaikh N, Craig JC, Rovers MM et al (2014). Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatr.168: 893–900. https://doi.org/10.1001/jamapediatrics.2014.637; PMid:25089634
Shaikh N, Morone NE, Bost JE et al. (2008). Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 270: 302–8. https://doi.org/10.1097/INF.0b013e31815e4122; PMid:18316994
Urinary tract infection in under 16s: diagnosis and management, clinical guideline CG54. United Kingdom National Institute for Health and Care Excellence. 2017.
Vaillancourt S, McGillivray D, Zhang X et al. (2007). To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. Pediatrics. 119: e1288–93. https://doi.org/10.1542/peds.2006-2392; PMid:17502345
Williams G, Craig JC. (2011). Cochrane Kidney and Transplant Group Long-Term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 39(1). https://doi.org/10.1002/14651858.CD001534.pub3
Zorc JJ, Kiddoo DA, Shaw KN. (2005). Diagnosis and management of pediatric urinary tract infections.Clin Microbiol Rev.18: 417–22. https://doi.org/10.1128/CMR.18.2.417-422.2005; PMid:15831830 PMCid:PMC1082801
Downloads
Issue
Section
License
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
