Urinary Tract Infections in Children

Infekcije mokraćnog sustava (IMS) među najčešćim su bakterijskim infekcijama u dječjoj dobi, osobito među ženskom djecom. Vodeći uzročnici IMS u djece su enterobakterije, osobito Escherichia coli, koja uzrokuje 70-90% svih infekcija. Osim u neonatalnoj dobi, sve IMS u djece razvijaju se kao posljedica ascenzije uzročnika iz uretre u više dijelove urotrakta. U razvoju IMS ključna je uloga virulencijskih čimbenika uropatogenih bakterija, ali i poticajna stanja domaćina, osobito postojanje anatomskih i funkcionalnih anomalija urotrakta. Uobičajena je podjela IMS u djece ovisno o lokalizaciji na akutni cistitis i akutni pijelonefritis, ovisno o prisutnosti poticajnoga stanja u domaćina na nekomplicirane i komplicirane te ovisno o frekvenciji pojavljivanja na akutne i recidivne infekcije. Temelj dijagnostike, a i ispravne antimikrobne terapije IMS je bakteriološka kultura urina s određivanjem antimikrobne osjetljivosti izoliranog uzročnika. Osim etiološke dijagnostike, u obradi svake IMS u djece nužno je potrebna i slikovna dijagnostika kojoj je prvenstveni cilj otkrivanje postojanja anomalije urotrakta. Iako je prognoza uroinfekcija u djece uglavnom dobra, ona ponajprije ovisi o pravodobno otpočetom liječenju. Antimikrobno liječenje u većine bolesnika s IMS izvan neonatalne dobi može se provesti u izvanbolničkim uvjetima. Samo rano otpočeta antimikrobna terapija smanjuje mogućnost trajnog oštećenja (ožiljčenja) bubrežnog parenhima u djece s pijelonefritisom. U djece s anomalijama urotrakta, kao i onih s recidivnim IMS važna je uloga profi laktičkog davanja antibiotika, kao i drugih profi laktičkih i korekcijskih mjera.Urinary tract infections belong to the most frequent bacterial infections in children, especially female children. The leading causative agents of urinary tract infections in children are enterobacteria, and primarily Escherichia coli that causes 70-90% of all infections. All urinary tract infections in children, other than in neonatal age result from ascension of pathogens from the urethra into upper parts of the urinary tract. The virulent factors of uropathogen bacteria play a key role in the development of urinary tract infections. The stimulating host factors, especially anatomic and functional abnormalities of the urinary tract, are also important in their development. Urinary tract infections in children are usually classifi ed by site of the infection into acute cystitis and acute pyelonephritis, by stimulating host factors into uncomplicated and complicated, and by incidence into acute and recurrent infections. The basis of diagnosis, and of the correct antimicrobial therapy of urinary tract infections, is urine culture with antibiotic sensitivity test of the isolated pathogen. In addition to ethiologic diagnosis, the analysis of any urinary tract infection in children also requires imaging diagnostics methods, primarily to determine the existence of urinary tract anomalies. Although the prognosis of urinary infections in children is generally good, it primarily depends on the timely onset of treatment. Antimicrobial treatment in the majority of patients with urinary tract infections, other than those of neonatal age, can be carried out in outpatient facilities. Only the early onset of antimicrobial therapy reduces the possibility of permanent damages (scar) of renal parenchyma in children with pyelonephritis. In children with urinary tract abnormalities, as well as in those with recurrent urinary tract infections, the prophylactic administration of antibiotics and other prophylactic and corrective measures are also important