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.

Acute pyelonephritis in children / W. Morello, C. La Scola, I. Alberici, G. Montini. - In: PEDIATRIC NEPHROLOGY. - ISSN 0931-041X. - 31:8(2016 Aug), pp. 1253-1265.

Acute pyelonephritis in children

G. Montini
Ultimo
2016

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.
Urinary tract infections; Acute pyelonephritis; Vesicoureteral reflux; Guidelines; Antibiotic prophylaxis; Antibiotic resistance
Settore MED/38 - Pediatria Generale e Specialistica
ago-2016
4-ago-2015
Article (author)
File in questo prodotto:
File Dimensione Formato  
Montini_PediatricNephrology_Pyelonephritis_2016.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 3.53 MB
Formato Adobe PDF
3.53 MB Adobe PDF   Visualizza/Apri   Richiedi una copia
art%3A10.1007%2Fs00467-015-3168-5.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 3.52 MB
Formato Adobe PDF
3.52 MB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/355568
Citazioni
  • ???jsp.display-item.citation.pmc??? 22
  • Scopus 88
  • ???jsp.display-item.citation.isi??? 66
social impact