Introduction : Extended-spectrum ?-lactamase (ESBL) is a mutated ?-lactamase enzyme that can hydrolyze beta-lactam antibiotics. The aim of this study was to determine the incidence rate, characteristics of patients, antibiotic use and outcome of urinary tract infections (UTIs) due to ESBL-producing Escherichia coli and Klebsiella pneumoniae at Dr Zainoel Abidin General Hospital Aceh.Method : The samples of this study were all Escherichia coli and Klebsiella pneumoniae isolated from urine culture of UTI cases. Patient characteristics and antibiotic use data were extracted from medical records. UTIs outcome was assessed as clinical improvement or death within a maximum of 30 days of treatment.Result : The results of this study obtained 63 patients with UTIs caused by E. coli and K. pneumonia of which 52.4% of them were ESBL producers. The incidence of UTIs due to E. coli was higher than that of K. pneumoniae, 63.5% and 36.5% respectively. E. coli ESBL producers were more in number than non-ESBL, conversely K. pneumoniae were mostly non-ESBL. The characteristics of patients with UTIs caused by E. coli and K. pneumoniae were predominant women 52.4%,  and most cases were at 56-64 years old. Antibiotic therapy that given before and after culture results to UTI patients were generally ceftriaxone. UTIs outcome due to ESBL producing Escherichia coli and Klebsiella pneumoniae showed that 26/33 (78.8%) patients experienced improvement, however, 7/33 (21.2%) patients died.Conclusion : The irrational use of ceftriaxone in patients with UTI caused by ESBL producing E. coli and K. pneumoniae has led to a poor outcome for the patient.

Bladder stones affecting children, especially in low-resource countries. Dietary, environmental, genetic inheritance, and socio-economic factors affecting the composition of bladder stones. Even though the etiology of bladder stones is unknown, recent research has identified many risk factors that may assist this pathological condition. Even though cystolithotripsy has now become the standard of care, many other approaches are indicated in specific conditions. Surgeons should diagnose and investigate the etiology of the diseases properly, thus a surgical approach is only used when it is needed. Therefore, this study aims to review bladder stones in children based on current literature to refer to other researchers and clinicians.

Urinary calculus is more commonly known in infants, and the urinary bladder is the most common location in the lower urinary tract for stone formation. There are three basic types of bladder calculus: Primary idiopathic/endemic, secondary, and migrant. The standard treatment of bladder calculus is open cystolithotomy or transurethral cystolitholapaxy. However, the use of a percutaneous approach has been promoted. We performed percutaneous cystolithotripsy with urethrocystoscopy guidance in children with bladder stones. The procedure was done without any ultrasound or fluoroscopic guidance. In children who required percutaneous cystolithotripsy with urethrocystoscopy guidance, we documented four cases of bladder stones. The diagnoses were made based on anamnesis, ultrasonography, physical examination, and X-ray imaging. In all patients, the operation was successful, and intraoperative results showed a single stone in each of the three patients and two stones in the same patient. This report aims to define the surgical challenges presented by bladder stones and the multidisciplinary approach needed to deal with them. Under ultrasound or fluoroscopic guidance, we performed percutaneous cystolithotripsy in children. The percutaneous cystolithotripsy was the most frequent outpatient treatment. The bladder was first filled with contrast material or water. A Foley catheter was inserted in the urethra and left for a period of 3–5 days. The rectus fascia defect was closed using the 2-0 vicryl suture. Percutaneous suprapubic lithotripsy is a safe and successful procedure for treating bladder stones in children. It is fast and linked to negligible complications.

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