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Primary urinary tract infection in infants: prophylaxis for uncomplicated pyelonephritis
Kong-Sang Wan1, Chih-Kuang Liu, Li-Hui Chen
1Department of Pediatrics, Taipei City Hospital, Yangming Branch and School of Medicine, National Yang-Ming University, Tapei, Taiwan. gwan1998@gmail.com
Insights
Four weeks of antibiotic treatment effectively manages infant urinary tract infections (UTIs). Imaging like DMSA scans are recommended for diagnosing pyelonephritis in infants with primary UTIs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infection (UTI) is a common cause of unexplained fever in infants (5-11% prevalence).
- This study evaluated diagnosis and treatment for 95 infants with primary UTI.
Purpose of the Study:
- To assess the effectiveness of a 4-week antibiotic regimen for infant primary UTI.
- To determine the utility of various diagnostic tools in identifying pyelonephritis.
Main Methods:
- Infants underwent renal ultrasonography, voiding cystourethrogram, and 99mTc dimercaptosuccinic acid (DMSA) scans.
- Treatment involved 2- or 4-week antibiotic therapy, with a follow-up DMSA scan at 6 months.
Main Results:
- Fever was the primary symptom; high white blood cell count and urinalysis were unreliable indicators of UTI.
- Urine culture colony counts and kidney ultrasonography were not predictive of pyelonephritis.
- A 1-week IV antibiotic followed by 3 weeks of oral antibiotics showed good prophylaxis for uncomplicated pyelonephritis.
Conclusions:
- Four weeks of antibiotic treatment led to good recovery in infant primary UTI cases.
- Voiding cystourethrogram, DMSA, and ultrasonography are recommended for primary infant UTIs.
Background:
Urinary tract infection (UTI) is one of the most common causes of unexplained fever in infants with a reported prevalence range of 5-11%. The clinical and laboratory findings were reviewed, and diagnosis and treatment for 95 infants with primary UTI were evaluated in this study.
Methods:
All patients underwent renal ultrasonography, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) scan during hospitalization before treatment, with treatment consisting of 2- or 4-week appropriated antibiotic therapy for the patients associated upper UTI, followed by a second DMSA scan 6 months after therapy.
Results:
In the present study the main symptom of UTI in infants was fever. High white blood cell count was not necessarily present, and urinalysis was also an imperfect diagnostic tool for discriminating UTI. In addition, colony count from urine culture and kidney ultrasonography was not efficacious in terms of predicting the occurrence of pyelonephritis. Intravenous antibiotic for 1 week followed by 3 weeks of the same oral antibiotic provided good prophylaxis for uncomplicated pyelonephritis.
Conclusion:
Four weeks of antibiotic treatment resulted in good recovery from pyelonephritis in the present sample of infant primary UTI cases. voiding cystourethrogram, DMSA and ultrasonography scanning should be performed in primary infant UTI.
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