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Management of urinary tract infection and vesico-ureteric reflux in children
1Department of Paediatrics, Singapore General Hospital.
Insights
Pediatric urinary tract infections (UTIs) require careful diagnosis and management, considering factors affecting urine cultures and specific bacterial strains. Treatment strategies, especially for vesico-ureteric reflux, vary by severity, with long-term outcomes of newer interventions still under investigation.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in children but challenging to diagnose and manage.
- Factors like urinary stasis, renal abnormalities, detrusor instability, host factors, and specific pathogens (e.g., P-fimbriated E. coli) influence UTI pathogenesis.
- Accurate diagnosis relies on awareness of potential interferences with urine culture results.
Purpose of the Study:
- To review the diagnostic and management complexities of pediatric UTIs.
- To discuss factors influencing UTI pathogenesis and urine culture accuracy.
- To evaluate treatment options for vesico-ureteric reflux (VUR) based on reflux grading.
Main Methods:
- Literature review of factors affecting pediatric UTI diagnosis and management.
- Analysis of treatment approaches for different grades of VUR.
- Evaluation of evidence for surgical versus medical management of VUR.
Main Results:
- Antibiotic selection for UTIs depends on patient age, clinical presentation, and culture results.
- Low-grade VUR (Grades I-II) often resolves spontaneously and is managed medically with low-dose antibiotics.
- Management of high-grade VUR (Grades III-IV) remains controversial; surgical reimplantation has not consistently prevented renal scarring or breakthrough infections.
Conclusions:
- Optimal management of pediatric UTIs requires a multifactorial approach considering patient-specific factors and causative agents.
- While medical management is effective for low-grade VUR, the efficacy of surgical interventions for high-grade VUR requires further investigation.
- Endoscopic Teflon injection for VUR shows promise short-term, but long-term efficacy and safety are yet to be determined.
Abstract:
Even though urinary tract infection is common in childhood, its diagnosis and management can be difficult. One must be aware of factors that may interfere with urine culture result. Besides urinary stasis, renal tract abnormalities and detrusor instability, host factors and certain strains of invading organisms (P-fimbriated E Coli) may be important in the pathogenesis of urinary trace infection. The choice of antibiotics for treatment of urinary tract infection should be guided by the age of the patient, clinical presentation and urine culture result. The management of vesico-ureteric reflux depends on its grading. Grade I and II can be treated medically by long-term low dose antibiotics because spontaneous resolution is high. For Grade III and IV, the treatment of choice is controversial. Controlled prospective studies showed that surgical reimplantation did not prevent new scar formation, progression of old scars and breakthrough infection. Endoscopic submeteric injection of Teflon is a new method to correct vesico-ureteric reflux. Despite favourable short-term results, the long-term outcome is unknown.