Urinary Tract Infection (UTI)2

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Infants or children under 2 years old with fever without source looks sick, antibiotics are given and urine samples were taken for culture by suprapubic aspiration or kateter.1 suprapubic aspiration is to take direct urine from the bladder with a needle. Possible contamination of the urine obtained by both methods is very small so both ways is the most reliable.

However, if a baby or child under 2 years with fever did not seem seriously ill, suprapubic aspiration or catheterization is sometimes considered berlebihan.1, 3 In this condition, urine sampling can be done in a way that is not invasive, for example:

• In the child who is old enough, can be done taking the urine mid-stream.3
* In infants or toddlers, it can be done taking the urine with the urine mid-stream urine container or bag attached to the perineum.3, 4

Urine sampling in this manner has a low risk of contamination if before making the perineum is cleaned thoroughly urine, urine collector bags are released immediately after the urine was obtained, and the stocks quickly diproses.1 In young women, the perineum should be cleaned from front to back with some sort of gauze soaked in warm water without antiseptik.3 If you can not directly be processed, the stocks should be stored in a temperature of 40. Preparations that have been stored up to 48 hours can still be used for the culture, but can not be used for the microscopic examination for cells that have been damaged.

Performed on urine samples were:

* Culture: Kultur (culture: breeding microorganisms) that will get rid of negative diagnosis ISK.1 While on a positive culture, urine sampling process must be observed. If a positive culture came from suprapubic aspiration or catheterization, the result is considered correct. However, if a positive culture was obtained from the urine collector bags, need to be confirmed by catheterization or suprapubic aspiration.
* Urinalysis: the most important components of urinalysis in UTI are leukocyte esterase, nitrites, and microscopic examination of leukocytes and bacteria. But there is no urinalysis component that can replace the importance of culture so that culture remains an imperative to diagnose ISK.1, 3

According to AAP, the number of bacterial colonies grown in culture for a positive, can be categorized as follows: 1

UTI diagnostic criteria

Likelihood of taking the urine of infected colonies (%)

Suprapubic aspiration of Gram-negative: whatever> 99%
Gram-positive:> a few thousand> 99%

Catheterization> 95% 105
Most likely an infection 104-105
103-104 doubt, repeat
<103 Possible infections not

Mid-stream / sac
Boys> 104 likely infection
Three daughters dosage 105 95%
2 105 90% stocks
1 105 80% stocks
5 × 104-105 doubt, repeat
104-5 × 104 + symptoms: doubt, repeat
- Symptoms: infection unlikely

Several parties have different restrictions regarding this criterion. For example the Royal Children's Hospital in Australia who use the 103 as a restriction of infection in urine samples obtained by kateterisasi.4 While on urine samples obtained from mid-stream, 108 in one stock is considered positive, and between 105-108 shows the initial infection and the need for re-examination .


In child two months - two years on suspicion of UTI and looked ill, antibiotics can be given parenterally (parenteral: intravenous) .1 Nursing at the hospital indicated if there are symptoms of sepsis or bacteremia (bacteremia: bacteria spread throughout the body via the circulatory ). Some parties indicated hospitalization and parenteral antibiotic use in children under 6 bulan.4

While on sick children who do not seem severe, antibiotics are generally given orally (drink). Some antibiotics that can be used are: 1.3

* Amoxicillin 20-40 mg / kg / day in three doses. Approximately 50% of UTI-causing bacteria resistant to Amoxicillin. But these drugs can still be given to UTI by bacteria sensitive to it.
* Co-trimoxazole or trimethoprim 6-12 mg trimethoprim / kg / day in two doses. Most of the ICS would show improvement with cotrimoxazole. Research indicates a greater cure rate in treatment with cotrimoxazole compared to Amoxicillin.
* Cephalosporin such as cefixime or cephalexin. Cephalexin roughly as effective as cotrimoxazole, but more expensive and has a broad spectrum so that it can interfere with normal intestinal bacteria or cause the growth of fungi (Candida sp.) In girls.
* Co-amoxiclav is used in UTIs with bacteria that were resistant to cotrimoxazole. The price is also more expensive than cotrimoxazole or cephalexin.
* Drugs such as nalidixic acid or nitrofurantoin not be used in children who feared having renal involvement in UTI. In addition nitrofurantoin are also more expensive than cotrimoxazole and has side effects such as nausea and vomiting.

Length of antibiotic treatment in general is the seventh day of UTI infections akut.3 While there are those who recommend 10-14 days, but given the long time it gives a greater possibility for the occurrence of resistance, the disruption of normal bacteria in the intestines and vagina, and cause candidiasis.

5 Selain itu juga tidak ada perbedaan berarti dalam kegagalan pengobatan antara kedua metode tersebut.6 Sehingga saat ini sebagian pihak menilai bahwa pemberian antibiotik jangka waktu pendek dapat dilakukan pada ISK tanpa komplikasi." onmouseover="this.style.backgroundColor='#ebeff9'" onmouseout="this.style.backgroundColor='#fff'">Giving antibiotics in the short term (<5> 5 In addition, there was no significant difference in treatment failure between the two methods tersebut.6 So when this part of some considered that the short-term antibiotic use can be made on the UTI without complications.

While treatment is generally carried out by parenteral cephalosporin such as ceftriaxone 75 mg / kg every 24 hours. Some parties choose gentamicin 7.5 mg / kg per 24 hours and benzylpenicillin at 50 mg / kg per 6 hours for children over one month

Besides antibiotics, treatment can be done to reduce such symptoms are fever-lowering drugs if diperlukan.3 other adults used for UTIs, are generally not recommended to be given to children.

If no improvement within 2 days after treatment, urine samples should be re-captured and re-checked ulang.1 culture after 2 days of treatment are generally not required if the improvement obtained and cultured bacteria previously sensitive to the antibiotics given. If the sensitivity of bacteria to antibiotics is granted or not conducted a test of sensitivity / resistance before, then repeat cultures performed after 2 days of treatment.

Continued Examination

After treatment with antibiotics is completed and the urine is sterile, made further investigation in children with ISK.1, three follow-up examination is the following:

* Ultrasonography kidneys, ureters, and bladder: This check is performed on all children with UTI as soon as possible.
* DMSA scan: This test is mainly to see the function of the urinary tract. DMSA scan is still debated the age restriction. However, usually done in children under 5 years with abnormal ultrasound results. Generally carried out two months after the episode of UTI to give a time improvement of the urinary tract. While waiting to do this inspection, several parties suggested a low dose of antibiotic.
* Cystogram: This is an examination of the bladder is also still debated the age restriction. But generally performed in children under 1 year or children with the results of ultrasound or DMSA abnormalities.

Examinations was performed earlier if there is no improvement after two days of antibiotic.

Other Matters Relating to UTI

Vur (vesico ureteral reflux) is the most common abnormality found on examination of this disorder happen lanjutan.1 The widening of the ureter that can continue to cause kidney damage. In children under 1 year with UTI, Vur can reach 50%. Vur there are various kinds of degrees, from the most mild to severe.

Recurrent UTI. UTI can be repeated once in 20% boys and 30% of girls, or more than once at 4% boys and 8% of children perempuan.3 own definition of recurrent UTIs are two or more UTIs in a period of six months .2 recurrent UTIs can lead to hypertension or renal failure kronik.3 Providing long-term antibiotics to prevent the recurrence of UTI did not have reasonable grounds. However, if a child has occurred or Vur recurrent UTIs, some parties advocated granting long-term low-dose antibiotics.


* Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. Pediatrics Vol. No. 103. 4 April 1999, pp. 843-852. Available from http://aappolicy.aappublications.org/cgi/content/full/pediatrics; 103/4/843
* Ahmed SM, Swedlund SK. Evaluation and Treatment of Urinary Tract Infections in Children. American Family Physician Vol 57 No 7 April 1998. Available from http://www.aafp.org/afp/980401ap/ahmed2.html
* Prodigy Guidance - Urinary tract infection - children available from http://www.prodigy.nhs.uk/guidance.asp?gt=UTI% 20 -% 20children
* Urinary Tract Infection Guidelines available from http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5241
* Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children (Cochrane Review). The Cochrane Library, Issue 3, 2005. Available from http://www.update-software.com/abstracts/ab003966.htm

Williams GJ, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children (Cochrane Review). The Cochrane Library, Issue 3, 2005. Available from http://www.update-software.com/abstracts/ab003966.htm

dr. Nurul H Itqiyah
sources web milissehat.web.id /? p = 30
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