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Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
Published on: July 18, 2017
Acute pyelonephritis in children
William Morello1, Claudio La Scola1, Irene Alberici1
1Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Via Massarenti 11, 40138, Bologna, Italy.
Insights
Acute pyelonephritis in children, often caused by E. coli, requires prompt diagnosis via urinalysis. Management balances effective treatment with minimizing antibiotic resistance and optimizing imaging strategies.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Urology
Background:
- Acute pyelonephritis is a severe childhood bacterial illness, frequently caused by Escherichia coli.
- Infants face risks of sepsis and meningitis; ambiguous symptoms and unreliable fever complicate early identification.
- Increasing isolation of other bacterial species (Klebsiella, Enterococcus, Enterobacter, Proteus, Pseudomonas) is noted.
Purpose of the Study:
- To review diagnostic and management strategies for acute pyelonephritis in children.
- To discuss current approaches to antibiotic treatment, imaging, and prophylaxis.
- To highlight areas needing further research for optimal long-term renal function preservation.
Main Methods:
- Diagnosis relies on urinalysis, with dipstick tests for nitrites and leukocyte esterase as key indicators.
- Urine culture via clean-voided methods is feasible even in young children.
- Outpatient oral therapy is viable for well-appearing children.
Main Results:
- New guidelines recommend less aggressive imaging post-infection, reducing radiation and costs.
- Antibiotic prophylaxis efficacy for preventing recurrence is debated.
- Antibiotic resistance is a concern, cautioning against widespread prophylactic use.
Conclusions:
- Accurate diagnosis is crucial, with urinalysis and urine culture being vital.
- Management strategies are evolving, emphasizing reduced imaging and cautious antibiotic use.
- Further randomized controlled trials are needed to refine imaging protocols and medical interventions for preserving renal function.
Abstract:
Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.
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