Untreated Bacteriuria in Asymptomatic Girls With Renal Scarring

Abstract

Recurrences of bacteriuria after treatment occur in 50% to 80% of asymptomatic patients. Previous experience with short-term treatment as well as longterm prophylaxis has been disappointing, with a significant risk of infections, ie, development of symptoms after treatment. Results with nontreatment are described in this report with reference to clinical course, renal growth, and glomerular filtration rate in 26 asymptomatic girls with established renal scarring and bacteriuria. Acute pyelonephritis was not seen in those with continuing bacteriuria or spontaneous clearance. Neither in scarred nor in unscarred kidneys did the duration of bacteriuria influence renal growth or glomerular filtration rate. Asymptomatic patients with bacteriuria may gain from nontreatment and may have a reduced risk of pyelonephritic attacks.

Urinary tract infection in pediatrics: an overview

“… 19 In some occasions, the prescription of broad-spectrum antibiotics for other infections may produce changes in the normal flora. 20 …”

Características clínicas del reflujo vesicoureteral en niños atendidos en el Hospital Universitario San Vicente de Paúl de Medellín,1960-2004

“…[35][36][37] Algunos autores restringen esta indicación a niños con episodios de pielonefritis aguda, pues la bacteriuria asintomática no parece asociarse con lesión renal progresiva. 38,39 Otras razones para considerar la cirugía incluyen una adhesión inadecuada al tratamiento médico o que se presenten dificultades con el uso de los medicamentos. 40 La mayoría de los autores están de acuerdo en que el reflujo primario grave (grado V) que persiste más allá de 1-2 años de edad debe ser corregido con cirugía, porque los ureteres de estos niños con frecuencia tienen estasis de orina, lo que genera un riesgo importante de pielonefritis.…”

A multinational survey on the management of the urinary tract in newborns with spina bifida: Are we following current EAU/ESPU guidelines?

“…Most importantly, the guidelines are very clear in regard to asymptomatic bacteriuria. Even though bacteriuria can be observed in over half of children on CIC, if patients are asymptomatic then they do not need treatment 13–15 …”

“…Even though bacteriuria can be observed in over half of children on CIC, if patients are asymptomatic then they do not need treatment. [13][14][15] Overactivity of the detrusor muscle leads to a highpressure bladder and subsequent complications in the upper urinary tract. 16,17 Anticholinergic medications can reduce detrusor overactivity and thus, lessen the intravesical pressure in SB patients.…”