Cystitis

Abstract

Urinary tract infection (UTI), when left undiagnosed, can lead to renal damage and dysfunction. Understanding how to diagnose, manage, and follow up a UTI is crucial to preventing such consequences.UTI may be classified as cystitis/ pyelonephritis, first/recurrent infection, or complicated/uncomplicated infection. Infections are considered complicated with the following factors: functional or anatomic abnormality of the urinary tract, an indwelling urinary catheter, recent urinary tract instru-mentation, male sex, pregnancy, recent antibiotic use, or immunosuppression. Although the focus of this In Brief is on uncomplicated cystitis, it is important to understand the risk factors for recurrence and complications when evaluating a child who has cystitis for the first time. In teenagers, uncomplicated cystitis is associated most commonly with sexual activity, and counseling is imperative to prevent future infections.Although the overall prevalence of UTI in febrile infants is approximately 5%, certain children are more at risk than others. Risk factors for UTI in a young child include sex (girls Ͼ boys), age (boys Ͻ1 years of age, girls Ͻ5 years of age), race (white Ͼ African American), circumcision (infant boys not circumcised Ͼ those circumcised), first-degree relative who has a history of recurrent UTIs, recent antibiotic use, catheterization, immunocompromise (renal transplantation, acquired immune deficiency syndrome, diabetes mellitus), constipation, voiding dysfunction, vesicoureteral reflux (VUR), neurogenic bladder, and urinary tract obstruction. For adolescents, the use of barrier contraception with spermicide increases the risk for UTI. Among infants, human milk is protective.In all age groups, the most common pathogen causing cystitis is Escherichia coli. In neonates, group B streptococci are a particular concern. Immunocompromised hosts are at risk for infection with less typical agents, such as Enterococcus, BK virus, Pseudomonas aeruginosa, and Candida albicans. Adolescent girls commonly have Staphylococcus saprophyticus infection. Many other agents have been associated with cystitis, including a wide range of gram-negative rods and cocci, grampositive cocci, adenovirus, and both Chlamydia trachomatis and Ureaplasma urealyticum. Lactobacillus, coagulasenegative staphylococci, and Corynebacterium are typical normal flora in children.Children who have cystitis often do not present with the characteristic signs and symptoms seen in adults. The history of a child who has fever should include documentation of the risk factors described previously to evaluate for UTI. Infants younger than 60 to 90 days of age may have vague and nonspecific symptoms, such as failure to thrive, diarrhea, vomiting, irritability, lethargy, malodorous urine, jaundice, and fever. In children younger than 5 years of age, fever and gastrointestinal symptoms are most common. The classic lower urinary tract symptoms of dysuria, urgency, frequency, incontinence, and suprapubic abdominal pain are more common after 5 years of age. The ...

Urinary neutrophil gelatinase associated lipocalin – A sensitive marker for urinary tract infection in children

“…[1234] Appropriate diagnosis and treatment prevent complications such as renal scarring, hypertension, proteinuria, and end-stage renal disease. [567891011] About 8% of girls and 2% of boys experience at least one episode of UTI upto the age of 7. [5] Early, aggressive antibiotic treatment has been recommended for symptoms suggestive of UTI in young children to prevent renal scarring.…”

Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis

“…A possible explanation for the development of UTIs in healthy children less than aged 4 years is evolving elimination and hygiene practices during infancy and toilet training periods 1,[17][18][19] ; whereas children older than 14 years are more likely to experience UTIs related to sexual activity. 16,17 Children between these ages, however, the former. [7][8][9][10]22 It is postulated that higher failure rates with oral β-lactams are owing to a greater likelihood of persistent vaginal bacterial colonization after antibiotic treatment has been completed.…”

“…We hypothesize that this finding was likely due to differences in risk factors in the aged 4 to 13 years group compared with younger and older children. A possible explanation for the development of UTIs in healthy children less than aged 4 years is evolving elimination and hygiene practices during infancy and toilet training periods 1,[17][18][19] ; whereas children older than 14 years are more likely to experience UTIs related to sexual activity. 16,17 Children between these ages, however, are less likely to develop UTIs unless there are anatomical abnormalities of the urinary tract, neurological abnormalities, or functional bowel control conditions.…”

Prescribing Pattern of Antimicrobials in Urinary Tract Infection at Outpatient Department in a Tertiary Care Hospital in Dhaka

“…Every woman has a 60% lifetime risk of developing bacterial cystitis which develops mostly before the age of 24 years. [2][3] A variety of uropathogens are involved, mainly aerobic Gram-negative bacilli such as Escherichia coli, Klebsiella, Proteus, Citrobacter, Acinetobacter, Morganella and Pseudomonas aeruginosa. 4 Culture sensitivity tests are also important in case of UTI to go for a specific antibiotic treatment rather than the empirical treatment for the patients.…”