Urinary tract infection is one of the "leaders" in the structure of childhood morbidity. This is a general term that refers to inflammatory processes that develop as a result of bacteria entering different parts of the urinary tract. By the age of five, about 8% of girls and 1-2% of boys had one or more episodes of the disease. The prevalence of the disease depends on sex and age: in 2 to 15 years - more often girls are ill, and among infants and newborns - boys. In pediatrics, the most common is pyelonephritis, asymptomatic bacteriuria and cystitis. The spectrum of microbial flora that causes urinary tract infections in children depends on the conditions of infection, the general immunity of the child, his age and sex. Leaders among pathogens are enterobacteria, mainly E. coli (in 50-90% of cases). Klebsiella, streptococcus, Staphylococcus, Proteus, Pseudomonas aeruginosa, enterococci, etc. can also be sown. As a rule, in children acute urinary tract infections cause one kind of microorganism, but with malformations of the urinary system and frequent relapses, it is possible to detect microbial associations. The emergence of urinary tract infection is promoted by conditions in which urodynamics are disturbed: vesicoureteral reflux, urolithiasis, neurogenic bladder, bladder diverticula, hydronephrosis, pyeloectasia, kidney dystopia, ureterocele, polycystic kidney, in boys - phimosis, and in girls - synechia of the labia. Urinary tract infections can often develop in children on the background of the pathology of the gastrointestinal tract: colitis, constipation, intestinal infections, dysbiosis, etc., as well as with various metabolic disorders (for example, glucosuria, dysmetabolic nephropathy). In infants, the development of infection is facilitated by the functional and structural immaturity of the tubular nephron and urinary tract. Late gestosis during pregnancy, infectious process, asphyxia and hypoxia of the child in childbirth and septicemia of newborns are also important. Infection in the urinary tract can get hematogenous and lymphogenous, as well as in case of non-observance of personal hygiene, improper washing of the child or during some manipulations (for example, bladder catheterization). Acute urinary infection usually occurs in the form of pyelonephritis (secondary obstructive and primary non-obstructive) and pyelocystitis. Less common are forms such as cystitis and cystourethritis, as well as asymptomatic bacteriuria. Pyelonephritis is an acute or chronic nonspecific microbial inflammation that occurs in the interstitial tissue and the pulmonary system of the kidneys, while the pathological process involves the blood and lymph vessels and tubules. Cystitis is a microbial-inflammatory process that develops in the wall of the bladder (mainly in its submucosal and mucous layer). Asymptomatic bacteriuria is a condition in which the clinical appearance of the disease is completely absent and the bacteria in the urine are detected. In the urinary system, the infectious-inflammatory process occurs most often with the existence of predisposing factors, which at any level interfere with the flow of urine. This allows us to identify the risk groups for the occurrence of a urinary tract infection:
- children who have suffered urodynamics as a result of urinary obstruction (urolithiasis, vesicoureteral reflux, anomalies in the development of urinary organs, nephroptosis, etc.);
- metabolic disorders in the urinary system - dysmetabolic nephropathy, hyperuricemia, glukozuria, etc .;
- neurogenic dysfunctions, as a result of which urinary tract motility is impaired;
- children who have reduced local and general resistance - often ill, premature, with immune and systemic diseases;
- genetic predisposition - the presence of urinary tract infections and developmental anomalies in relatives;
- children with chronic bowel pathology and constipation.
- On the localization of inflammation, infection of the upper parts of the urinary system - ureters (urethritis) and kidneys (pyelitis, pyelonephritis), as well as the lower sections - urethra (urethritis) and bladder (cystitis), is distinguished.
- For the period of the disease, his debut (the first episode) and relapse (due to reinfection, persistence of the pathogen and unresolved infection) are isolated.
- Severity of symptoms distinguishes between severe and mild urinary tract infections in children.
Symptoms of a urinary tract infection in a childThe clinical symptomatology of urinary tract infection in children depends on the severity of the disease and its period, as well as the localization of the inflammatory process. The most common are pyelonephritis, cystitis and asymptomatic bacteriuria.
- Pyelonephritis in children is accompanied by febrile body temperature (38-38.5 ° C), chills, as well as symptoms of intoxication (headache, lethargy, decreased appetite, pale skin). At the height of intoxication, vomiting, frequent regurgitation, neurotoxicosis, diarrhea, and sometimes even meningeal symptoms may occur. The child complains of pain in the abdomen or lumbar region, the pain is aggravated by effleurage. In older children, the disease can hide under the guise of an influenza-like syndrome, and at an earlier age - an acute abdomen, dyspeptic disorders, pilorospasm, etc.
- For cystitis in children, first of all, characterized by dysuric disorders - painful and frequent urination in small portions. In this case, the bladder is simultaneously and completely not emptied, possibly incontinence. In infants, cystitis often accompanies strangury (urine retention). Children of the first year of life are restless during urination, crying, their urine stream is weak and intermittent. Cystitis worries about discomfort or pain in the suprapubic region, body temperature, usually subfebrile or normal.
- Asymptomatic bacteriuria is mainly found in girls. This form of urinary tract infection in children can be found in a laboratory examination, subjective clinical signs are not present. In some cases, parents can pay attention to the unpleasant smell coming out of the urine or its turbidity.
DiagnosticsDiagnosis of a urinary tract infection in a child is possible on the basis of a bacteriological study of urine. For this, it is important for parents to make urine feces correctly. In children who control the bladder, urine collection is done in the morning. The child before the fence must be sure to wash, wipe with a napkin. Doing a fence of urine in girls, it is desirable to cover the vagina with a cotton swab. For analysis, take an average portion of urine, since in the first there is a lot of periurethral flora. If bacteria are found in the urinalysis, the test should be repeated to avoid an incorrect diagnosis, and in the future - the vain use of antibacterial agents. With urinary tract infection in the urine, lymphocytes, erythrocytes, bacteria are found, protein can appear. A more accurate diagnosis is carried out using samples from Nechiporenko, Zimnitsky, Adiss-Kakovsky. To diagnose infection of the urinary system, the presence of protein or erythrocytes in urine does not matter, excluding pyelonephritis and cystitis will help the absence of leukocyturia.
In a general blood test for urinary tract infections, there is an increased ESR and neutrophilic leukocytosis.For diagnostic purposes, ultrasound examination of the bladder and kidneys, radioisotope radiography, excretory urography is also performed.
Treatment of UTI in childrenAn important place in the treatment of urinary tract infections belongs to antibacterial agents. Until bacteriological diagnosis is established, initial empirical antibiotic therapy is prescribed. For the treatment of urinary tract infections in children, currently inhibitor-protected penicillins (for example, amoxiclav), cephalosporins (ceftriaxone, cefotaxime), aminoglycosides (amikacin), carbapenems (imipenem, meropenem) and uroantiseptics (furagin, furadonin) are preferred. In addition, the reception of non-steroidal anti-inflammatory drugs (ibuprofen), antioxidants (vitamin E), desensitizing agents (alerone, claritin, tavegil) is indicated. In addition, you can use herbal medicine (chamomile, leaf cranberries, kidney teas). The course of treatment lasts an average of 7-14 days. After it, the child is shown a second laboratory examination. When the acute process abates, children undergo physiotherapy: electrophoresis, UHF, microwave, coniferous baths, ozocerite and paraffin applications, mud therapy. At the time of treatment, the child must always follow a diet, do not eat at this time, sharp and rough food, restrict the use of table salt.
ForecastParents need to remember that improper treatment of the disease leads to its chronicization and the development of various complications. In advanced cases, it is possible to permanently damage the renal parenchyma, hypertension, wrinkling of the kidney, sepsis.
In 15-30% of cases, recurrence of the disease is possible, so children at risk are assigned antiretroviral prophylactic treatment using uroantiseptics and antibacterial agents. The child is under constant supervision of a nephrologist and pediatrician. Vaccination is performed with complete clinical and laboratory remission.