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Ovidiu Brumariu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

The frequency of urinary tract infections in children with antenatal hydronephrosis

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 4, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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The frequency of urinary tract infections in children with antenatal hydronephrosis

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ABSTRACT

Infants with antenatal hydronephrosis are at risk 12 times greater of developing acute pyelonephritis. We evaluated the frequency of urinary tract infections (UTI) in a group of 87 patients with congenital hydronephrosis (HN) detected antenatally (ratio B: F = 2,95:1). The average follow-up was 20.22 months. 49.42% of children had UTI, the recurrence rate (≥ 2 episodes) was 53.8%. Depending on the degree of hydronephrosis, urinary infection rate was between 37.5 to 41.37% for grade I-II HN and between 57-71% for grade III-V HN (p = 0.0402, 95% CI grade I-II HN compared with grade III-V). We found a weak positive correlation between the degree HN and the number of UTI (rs = 0.224, p = 0.036, 95% CI) significant statistic. 60.52% of patients with a history of UTI had urinary infections on uroprophylaxis. Cefaclor was the most common used antibiotic. E coli was involved in 36.35% of UTI, and Klebsiella pn. 25%. Given the high frequency of urinary infections in this group, it is neccesary a longer follow-up of these children for early detection of kidney damage.

Key words: congenital hydronephrosis, urinary tract infections, uroprophylaxis, antenatal diagnosis, UTI reccurence, antenatal hydronephrosis

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RATA INFECTIILOR URINARE LA COPIII CU HIDRONEFROZA CONGENITALA DEPISTATI ANTENATAL

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 4, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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RATA INFECTIILOR URINARE LA COPIII CU HIDRONEFROZA CONGENITALA DEPISTATI ANTENATAL

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REZUMAT

Nou-născuţii depistaţi antenatal cu hidronefroză sunt supuşi unui risc de 12 ori mai mare de a dezvolta o pielonefrită acută. În prezenta lucrare am evaluat frecvenţa infecţiilor urinare pe un lot de 87 de pacienţi cu hidronefroză congenitală depistată antenatal (raport B:F = 2,95:1). Durata medie de urmărire a fost de 20,22 luni. 49,42% dintre copii au prezentat infecţii urinare, rata recidivelor(≥ 2 episoade infecţioase) fiind de 53,8%. Funcţie de gradul hidronefrozei, frecvenţa infecţiilor urinare a fost între 37,5-41,37% în cazul HN grad I-II şi între 57-71% în cazul HN grad III-V (p = 0,0402, CI 95%, HN gr. I-II comparativ cu HN gr. III-V). Am găsit o corelaţie pozitivă, dar slabă între gradul HN şi numărul de episoade infecţioase (rS = 0,224, p = 0,036, CI 95%) semnificativă statistic. 60,52% dintre pacienţii cu istoric de ITU au prezentat infecţii urinare sub uroprofilaxie. Cefaclor a fost cel mai utilizat antibiotic. În etiologia infecţiilor urinare E. coli a fost implicat în 36,35% dintre cazuri, iar Klebsiella pn. în 25%. Având în vedere frecvenţa crescută a infecţiilor urinare în acest lot, este necesară o urmărire mai îndelungată a acestor copii pentru depistarea precoce a afectării renale.

Cuvinte cheie: hidronefroză congenitală, infecţie urinară, uroprofilaxie, diagnostic antenatal, hidronefroză antenatală, infecţii urinare recidivante

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ASPECTE CLINICO-EVOLUTIVE ALE INFECTIEI URINARE LA PREMATUR

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ASPECTE CLINICO-EVOLUTIVE ALE INFECTIEI URINARE LA PREMATUR

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REZUMAT

Obiectiv. Studiul îşi propune analiza comparativă a cazurilor de ITU la copii 0-3 ani (prematuri şi născuţi la termen) internaţi în Clinica IV Pediatrie Iaşi, între ian. 2007 – dec. 2011. Material şi metodă. Am efectuat un studiu retrospectiv pe un lot de 298 de copii între 0-3 ani, internaţi cu infecţie de tract urinar (ITU). Au fost urmărite particularităţile ITU la prematur în funcţie de gradul prematurităţii, etiologia ITU, comorbidităţi, aspecte evolutive, responsivitate la tratament şi impactul ITU asupra rinichiului. Rezultate. Lotul de studiu a fost alcătuit împărţit în copii născuţi la termen şi copii născuţi prematur, la vârstă gestaţională mai mică de 37 săptămâni, cu greutatea mai mică de 2.500 g. Riscul ITU la prematur este influenţat de vârstă, fiind de 3 ori mai mare la nou născutul prematur faţă de copilul 1-3 ani. Vârsta medie a fost de 8,8 luni la prematuri şi 14,09 luni la născuţii la termen. Cei mai mulţi copii s-au încadrat în gradul LBW. Etiologia infecţiei urinare a fost dominată la ambele subloturi de Escherichia coli, Proteus mirabilis şi Klebsiella pneumoniae. La prematuri, bacteriile oportuniste (bacil Piocianic, Enterococ, Acinetobacter) determină 16% din ITU, faţă de doar 2% la copii născuţi la termen. Febra a fost semnul clinic dominant la toţi pacienţii. În ordinea frecvenţei, celelalte semne prezente la prematuri au fost inapetenţa, icter prelungit, diaree, detresă respiratorie. Debutul prin insuficienţă renală acută s-a înregistrat la 12,5% dintre prematuri şi doar 1% dintre copii născuţi la termen. Tratamentul antibiotic iniţiat empiric a fost eficient la majoritatea cazurilor. Cel mai frecvent implicate în rezistenţa microbiană au fost aminopenicilinele, Trimetoprim-Sulfmetoxazolul şi Cefalosporine. Concluzii. Diagnosticul prompt şi tratamentul adaptat au un rol important în reducerea morbidităţii infecţioase, a riscului de cicatrici renale şi a reabilitării nutriţionale rapide a prematurului.

Cuvinte cheie: infecţie urinară, prematuritate, anomalii congenitale renale, copii 0-3 ani

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CLINICAL ASPECTS AND EVOLUTION OF URINARY TRACT INFECTION IN PRETERM INFANTS

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
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Promoting Global Health

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CLINICAL ASPECTS AND EVOLUTION OF URINARY TRACT INFECTION IN PRETERM INFANTS

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ABSTRACT

Objective. The aim of the study is a comparative analysis of cases of UTI in children 0-3 years (preterm and term infants) admitted to the IVth Pediatric Clinic , “Sf. Maria” Emergency Hospital for Children, Iasi, between January 2007 – December 2011.

Material and methods. We performed a retrospective study on a group of 298 children, age 0-3 years, hospitalized with urinary tract infection (UTI). We identified the features of preterm infants with UTI according to the degree of prematurity, UTI etiology, comorbidities, developmental issues, responsiveness to treatment, and impact of UTI on kidney.

Results. The study group was divided into term and preterm children (defined as gestational age less than 37 weeks, weighing less than 2500g). Preterm UTI risk was influenced by age, being 3 times higher compared with children aged 1-3 years. The average age of UTI was 8.8 months for preterms and 14.09 months for term babies. Most preterm children were classified in LBW category. The etiology of urinary infection was dominated in both subgroups by E. coli, Proteus mirabilis and Klebsiella pneumoniae. In preterm children, opportunistic bacteria (bacillus Pseudomonas, enterococci, Acinetobacter) determined 16% of UTIs, compared to only 2% in term children. Fever was the dominant clinical sign in all patients. Other signs on preterms were loss of appetite, prolonged jaundice, diarrhea, respiratory distress. The onset of acute renal failure occurred in 12.5% of preterm and only 1% of term children. First line antibiotherapy was effective in most cases. In microbial resistance, the most frequently involved were aminopenicillins, Sulfamethoxazole-Trimethoprim and cephalosporins.

Conclusions. The early diagnosis and treatment have an important role in reducing infectious morbidity, the risk of renal scarring and rapid nutritional rehabilitation in preterm infants.

Keywords: urinary tract infection, preterm infant, CAKUT, E.coli

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