Recent Studies on the Care of First Febrile Urinary Tract Infection in Infants and Children for the Pediatric Hospitalist

Sutton, Ashley G.; Chandler, Nicole; Roberts, Kenneth B.

doi:10.2174/1574887112666170816143639

Cited by 6 publications

(3 citation statements)

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“…Escherichia coli is by far the most common microbe in simple UTIs. 4 Although E. coli accounts for the maximum number of UTIs, other microbes of significance comprise Proteus, Klebsiella, and Enterococcus. The determination of UTIs is performed by obtaining the medical history of the patient and urine analysis; however, the appropriate collection of the urine sample is important.…”

Section: Introductionmentioning

confidence: 99%

Importance of Antimicrobial Stewardship in the Treatment of Urinary Tract Infection

Bakshi¹,

Kaur²,

Gill³

2021

J. Pure Appl. Microbiol.

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Urinary tract infection (UTI) is a microbial contamination of the bladder and related organs. Study subjects were those who had no structural anomaly and no co-occurring diseases, such as diabetes, or were either immunocompromised or pregnant. Simple UTI is also defined as cystitis or inferior UTI. This study was a prospective, single center study conducted at a tertiary level clinic and its associated bacteriology laboratory. Patients whose urine tests were collected by the microbiology test center over a 6-month period were enrolled in the study. Culture and vulnerability results were obtained directly from the microbiology test center. Of the 1306 samples obtained, 888 (68%) were from females and 418 (32%) from males. This study identified the predominant UTI-causing microbes and the associated antimicrobial vulnerabilities. In males, Escherichia coli (36.8%) was the predominant microbe followed by Klebsiella pneumoniae 19.8%, Proteus spp. 17.4%, Staphylococcus aureus 10.0%, Pseudomonas aeruginosa 5.5%, Citrobacter spp. 5.0%, Staphylococcus saprophyticus 0.7%, Enterococcus faecalis 1.4%, and Acinetobacter spp. 0.7%. In females, E. coli (49.4%) was predominant, whereas Acinetobacter spp. (0.3%) was the least dominant. The considerable susceptibility of E. coli to meropenem (73.6%) and imipenem (73.5%) was similar to that reported in different investigations across India. In this study, the susceptibility of E. coli to piperacillin + tazobactam and ciprofloxacin was 42.7% and 14.3%, respectively. Stewardship of urinalysis and urine culture, especially among clinicians might be a successful upstream strategy for reducing inappropriate antimicrobial use for UTI. Thus, it is critical to routinely screen for resistance or susceptibility in samples of uropathogens, so the protocols for proper antibiotic treatment can be enhanced to incorporate antimicrobials with less resistance, supporting physicians in the appropriate treatment of UTIs resulting in insignificant remedial disappointments.

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Section: Introductionmentioning

confidence: 99%

Importance of Antimicrobial Stewardship in the Treatment of Urinary Tract Infection

Bakshi¹,

Kaur²,

Gill³

2021

J. Pure Appl. Microbiol.

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“…Just a few decades ago, identifying VUR to immediately initiate treatment to prevent UTI and minimize the risk of renal damage was problematic . Now that the natural history of VUR has become clearer, several treatment modalities have been introduced, but recently, the potential risks of overdiagnosis and overtreatment of low‐risk VUR as well as follow‐up VCUG and long‐term CAP have been emphasized, and watchful waiting has been proposed as an option. Classically, CAP is offered as first‐line treatment on the understanding that VUR might resolve spontaneously, but how long CAP must be continued before reflux resolution in the individual patient cannot be determined…”

Section: Introductionmentioning

confidence: 99%

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

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“…However, we noted that the majority of the direct analysis protocols developed require a large volume of urine sample and a minimum of 10 5 CFU/ml in order to correctly identify the pathogen. It is not always possible to collect 10 ml or more of urine, especially from infants who are commonly affected with UTIs when diagnosed with a bacterial infection (11).…”

mentioning

confidence: 99%

Direct Identification of Pathogens in Urine by Use of a Specific Matrix-Assisted Laser Desorption Ionization–Time of Flight Spectrum Database

et al. 2019

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Urinary tract infections are among the most common reasons for antimicrobial treatment, and early diagnosis could have a significant impact by enabling rapid administration of the adapted antibiotic and preventing complications. The current delay between sample receipt and pathogen identification is about 24 to 48 h, which could be significantly shortened by use of an accurate direct method. Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) is already used for the identification of pathogens in clinical laboratories and constitutes a promising tool for direct diagnosis. A simple preparation protocol was established for the processing of urine samples prior to MS analysis. MALDI-TOF spectra collected directly from 1,000 infected urine samples were used to create a specific reference database (named Urinf). A prospective study was then carried out to evaluate the Urinf database and compare the results obtained with the standard database provided by Bruker on the Biotyper Real Time Classification software. Seven hundred eighty urine specimens were processed and analyzed according to our method. Among them, almost 90% of 500 infected monobacterial samples could be correctly diagnosed with the Urinf database, compared to 50% using the standard database. The identification of Enterobacteriaceae, Staphylococcus aureus, Staphylococcus saprophyticus, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterococcus faecium was greatly improved but not for Staphylococcus epidermidis. The creation of a database adapted to a particular type of clinical sample has great potential to increase both the rate and rapidity of pathogen identification. Sensitivity still remains to be improved for bacterial species that exhibit few specific peaks on mass spectra.

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Recent Studies on the Care of First Febrile Urinary Tract Infection in Infants and Children for the Pediatric Hospitalist

Cited by 6 publications

References 0 publications

Importance of Antimicrobial Stewardship in the Treatment of Urinary Tract Infection

Importance of Antimicrobial Stewardship in the Treatment of Urinary Tract Infection

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

Direct Identification of Pathogens in Urine by Use of a Specific Matrix-Assisted Laser Desorption Ionization–Time of Flight Spectrum Database

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