New Insights for Febrile Urinary Tract Infection (Acute Pyelonephritis) in Children

Lee, Kyung-Yil

doi:10.3339/jkspn.2016.20.2.37

Cited by 15 publications

(23 citation statements)

References 45 publications

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“…Moreover, it is known that abnormal findings on DMSA scans are found more often in patients with vesicoureteral reflux (VUR) than in those without VUR, and the positive rate correlates with the severity of VUR 6) . These findings suggest that the im mune status of the host, size of the focus, i.e., severity of inflammation, and anatomical defects in kidneys may be associated with positive findings for abnormal defects in DMSA scans 3) .…”

Section: Introductionmentioning

confidence: 84%

“…Interestingly, in contrast to other ex ternal pathogen infection such as tuberculosis and malaria 10,11) , infants with APN in this series may have milder phe notypes compared to children, since the infant group had a shorter total fever duration, lower CRP value and DMSA scan positivity compared to the children group. It is possible that febrile infants with APN visited the hospital earlier and received early antibiotic treatment or the bacterial uropa thogens in APN, including E.coli, are not external patho gens but they originate from the host 3) .…”

Section: Discussionmentioning

confidence: 99%

“…Childhood APN has unique demographic characteristics; it mainly affects infants (01 year of age) with a male predominance; and after 2 years of age, female predominance has been noted 2) . It is suggested that the immature immune status of infancy is related to the pathogenesis of APN 3) . Although the pathogenesis of renal cell injury in APN remains unknown, it is believed that APN has a focus in the renal parenchyma, where uropatho gens replicate extracellularly and produce toxic substances against the renal cells.…”

Section: Introductionmentioning

confidence: 99%

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Clinical implications of DMSA Scan in Childhood Acute Pyelonephritis

et al. 2017

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This study aimed to evaluate the relationships between 99mTecniciumdimercaptosuccinic acid (DMSA) scan findings and clinical parameters including age and fever duration. Methods: The positive rates for abnormal DMSA scans were analyzed according to the age of patients, fever duration prior to admission, and total fever duration. DMSA scan findings were divided into 3 categories: single defect, multifocal defects, and discrepant defects. We evaluated the detection rates of vesicoureteral reflux according to DMSA scan lesions. Results: Among a total 320 cases, 141 (44.1%) had abnormal DMSA scans. The in fant group (0-1 year of age) had a shorter total fever duration, and a lower Creac tive protein (CRP) value and DMSA positive rate (39.8% vs. 60.6%, P=0.002) com pared to children group (2-15 years of age). Patients with abnormal scans had a longer total fever duration and higher CRP compared to those with normal scans. The positivity rate of abnormal scans did not differ between the patients with a short fever duration prior to admission of ≤2 days and those with longer fever du ration of ≥3 days. However, patients with longer total fever duration had a higher rate of abnormal DMSA scans (P=0.02). Among cases with a single defect, multi focal defects, and discrepant defects, vesicoureteral reflux was observed in 22.4%, 60% and 70.6% of cases, respectively (P=0.004). Conclusion: Although DMSA scan has limitations in early diagnosis, DMSA scan findings may aid in the prediction of the severity of systemic inflammation and detection of vesicoureteral reflux.

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Section: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical implications of DMSA Scan in Childhood Acute Pyelonephritis

et al. 2017

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“…3) The reasons behind these distinct epidemiologic patterns of fUTI are unknown. However, many studies have attempted to explain these patterns on the structural differences in the genital areas influencing the variable risks of ascending infections, the immature immune status of children during infancy, 12) or the difference in the degree of periurethral/perineal colonization between the sexes which causes not only ascending infections but gut microbiota's bacterial translocation. 13) The burden of rapidly growing antibiotic resistance is an important issue recognized globally.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

et al. 2021

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Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 [interquartile range, 3.0-10.5] months) fit the inclusion criteria; of them, 78.0% (n = 280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%) and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (p < 0.001) and extended-spectrum beta-lactamase (ESBL) producers (p < 0.001) were observed. In patients with vesicoureteral reflux, the overall recurrence rate was 53.6% (n = 15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, p = 0.03). Conclusion: FUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than non-carbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative A c c e p t e d A r t i c l e rods to reduce short-term recurrence rates.

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“…As febrile UTI may lead to acute renal parenchymal da mage, possible permanent renal scarring, decreased renal function and end stage renal disease, early diagnosis and treatment are important. The majority (over 7080%) of febrile UTI during childhood is known to occur in the first year of life with a male predominance 1,2) . Infants are more likely to have febrile UTI than elderly due to immune system immaturity, high incidence of sys temic infections, and anatomical anomalies of urinary tract 3) .…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Febrile UTI First Developed Over 5 Years of Age

et al. 2017

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Purpose: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. Methods: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. Results: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. Conclusions: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.

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New Insights for Febrile Urinary Tract Infection (Acute Pyelonephritis) in Children

Cited by 15 publications

References 45 publications

Clinical implications of DMSA Scan in Childhood Acute Pyelonephritis

Clinical implications of DMSA Scan in Childhood Acute Pyelonephritis

Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

Clinical Characteristics of Febrile UTI First Developed Over 5 Years of Age

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