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ABSTRACT
In this article, the author presents clinical and laboratory data and analysis of pathogenic flora in patients with surgical
pathologies of the urinary tract, sensitivity to antibiotics and early empirical antibiotic therapy in children.
KEYWORDS
Antibiotic therapy, urinary tract infection.
INTRODUCTION
Despite the advances of modern medicine in the field
of pediatric urology,in recent yearsdiagnosis and
treatmentdiseases of the kidneys and urinary tract are
increasingly attracting the attention of specialists,
which is largely due to the fairly high prevalence of this
pathology among children, the seriousness of the
prognosis, the intensive search for ways of early
diagnosis, new principles of treatment and prevention
of possible complications [1,2,3,12, 17.23].
According to world literature, the prevalence of urinary
tract infection (UTI) among children ranges from 5.6 to
27.5%. On average, it is 18 cases per 1000 children's
population [16,18,22,24]. The outcomes of UTI can be
different: from favorable (in the absence of congenital
anomalies of UTI and timely treatment) to serious long-
term consequences, including arterial hypertension,
sclerosis, and impaired renal function, up to the
development of chronic renal failure with loss of
function requiring dialysis [5, 6,7,8,15,19,21,25]. Clinical
manifestations of UTI in children vary from unclear
fever to symptoms from the gastrointestinal tract
(GIT), upper and lower parts of the UTI, which often
complicates timely diagnosis and is the reason for late,
Research Article
CHARACTERISTICS OF URINARY TRACT INFECTION IN CHILDREN
Submission Date:
November 01, 2023,
Accepted Date:
November 05, 2023,
Published Date:
November 09, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue11-03
Shukrulloev F.Z.
Bukhara State Medical Institute. Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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delayed treatment. This is especially true for infants
and young children [9,10,11,14,20,26].
In this regard, research aimed at identifying the most
significant laboratory data and clinical symptoms in the
diagnostic aspect is of considerable interest to
pediatric urologists and clinicians, which allows them
to correctly assess the patient’s condition in the early
stages of UTI development, prescribe the correct
targeted treatment and reduce the risk of
complications, improve quality of life of sick children
[13,21,27]. .
PURPOSE OF THE STUDY
Study of clinical and laboratory features of urinary tract
infection in sick children.
Materials and methods of research.We examined 46
children with UTI aged from 1 month to 17 years,who
were undergoing inpatient treatment in the
department of pediatric surgery and urology of the
Bukhara Regional Multidisciplinary Children's Medical
Center (BOMDMC), which is the clinical base of the
Department of Pediatric Surgery of the Bukhara State
Medical Institute for the period 2019 - 2022.The
distribution of children by gender was as follows: 30
(65.2%) girls and 16 (34.8%) boys. Children of primary
school age and teenagers predominated. All children
underwent a complex of general clinical examinations,
including analysis of complaints, history taking,
objective examination, as well as clinical blood and
urine tests.For early diagnosis of UTIs, screening test
reagents were used, which allow determining the
presence of leukocyte esterase, nitrites and protein in
the urine.If necessary, additional instrumental
examination methods were used (ultrasound,
radiography, etc.)
RESULTS AND DISCUSSION
Of all 46 children with UTI examined, 29 (63%) sick
children had cystitis, 8 (17.4%) sick children had
pyelonephritis, 9 (19.6%) sick children had a combined
pathology of the urinary system. In 12 (26%) sick
children, a hereditary burden of the urinary system was
established. Congenital anomalies of the genitourinary
system were found in 5 (10.9%) of the examined:
anomalies of the kidneys and pyelocaliceal system
(4.3%) of sick children, anomalies of the genital organs
(4.3%) of sick children, hydronephrosis (2.2% ) sick
children. In 19 (41.3%) patients, underlying conditions
were identified (weight deficiency (19.6%), delayed
physical development (21.7%) in sick children, anemia in
(23.9%) sick children. Chronic ENT diseases - organs
were found in 10 (21.7%) children, concomitant
pathology of the gastrointestinal tract in 6 (13%)
patients. Particular attention is required by the fairly
high frequency in the anamnesis of acute intestinal
infections among past diseases (60.8%) of sick children
, as well as acute respiratory diseases of the upper
respiratory tract (87%) of sick children. The leading in
the clinical picture of UTIs were intoxication, pain and
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dysuria syndromes. Intoxication syndrome was
observed in 11 (23.9%) children and was manifested
mainly by lethargy, weakness, decreased appetite,
pallor of the skin and peri-orbital shadows. It was more
often observed in patients with pyelonephritis or
combined UTIs. Increased div temperature at the
time of presentation was detected in 24 (52.2%) of the
examined children. As a rule, these were sick children
with dysuric syndromes. In patients with cystitis,
regardless
of
its
form,
dysuric
syndrome
predominated. A number of patients experienced
symptoms from the gastrointestinal tract: nausea
(19.5%), vomiting (13%), unstable stool (15.2%) cases. A
clinical blood test at the time of treatment revealed
leukocytosis in 12 (26%) sick children, ESR was
accelerated in 16 (34.8%) sick children. Changes in
hemoglobin levels were observed in 11 (23.9%) sick
children, erythrocytes in 12 (26%) sick children, platelets
in 8 (17.4%) patients. According to a general urine test
at the time of admission, only 8.7% of cases showed no
pathological changes. Leukocyturia was detected in
30.4% of sick children, proteinuria in 6.5% of sick
children, oxaluria in 32.6% of sick children, and uraturia
in 17.4% of sick children. No bacteriuria was recorded in
a single urine sample. The relative density of urine was
changed in 2 (4.3%) sick children.
An ultrasound examination of the urinary system
performed by the patient revealed changes in the walls
of the collecting system as an ultrasonographic sign of
pyelonephritis in 4 (8.7%) sick children. Changes in
kidney size were detected in 5 (10.9%) sick children,
congenital hydronephrosis - in 2 (4.3%) sick children,
and the presence of stones in 3 (6.5%) patients.
A bacteriological examination of urine revealed an
increase in microflora in 20 (43.5%) sick children.
Escherichia coli predominated in the structure of the
isolated bacterial flora - 46% of cases.The distribution
of the remaining pathogens was as follows:
Staphylococcus epidermidis - 2.2%, Staphylococcus
aureus - 2.2%, Klebsiella pneumonia - 4.3%, Proteus
mirabilis - 2.2%, Pseudomonas aeruginosa - 4.3%.
Candida albicans was isolated from 1 (2.2%) sick child,
Candida tropicalis was isolated from 1 (2.2%) sick child.
Associations of pathogens were identified in 4.3% of
crops.
According to many authors, bacteriuria is considered
one of the obligatory symptoms of UTI, however, most
pediatric nephrologists are unanimous that the
frequency of positive results of bacteriological tests of
urine for microflora does not exceed 50
–
55%, and is
often even significantly lower [2,5]. We must not
forget that the absence of microflora does not exclude
the infectious onset of the disease. This fact may be
associated with the transition of bacteria into L-forms
and protoplasts [6]. In addition, the lack of growth of
pathogens during bacteriological urine culture can also
be explained by the start of taking broad-spectrum
uroseptics and antibacterial drugs at the time of
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sample collection. When analyzing the dependence of
microbial contamination of urine on gender, it was
found that 70% of the inoculated microflora was found
in girls, which is most likely due to the anatomical
characteristics of the female div. Among the isolated
uropathogens, the greatest sensitivity was registered
to ciprofloxacin, but we must not forget that this drug
is used in children over 14 years of age, only under strict
indications. From the spectrum of antibacterial drugs
frequently used in pediatrics, sensitivity to 3rd and 4th
generation
cephalosporins,
gentamicin,
and
meropenem was optimal. The lowest sensitivity was
noted to penicillin drugs.
Thus, the results of our study indicate that the modern
course of UTI in children is characterized by a variety of
clinical symptoms, the presence of a number of
associated pathologies, as well as a high frequency of
concomitant anomalies of the genitourinary system,
which create the preconditions for a microbial
inflammatory process in the urinary tract. A fairly large
percentage of false negative results of bacteriological
examination of urine, which can also be attributed to
modern features of UTI associated with the
widespread and uncontrolled use of antibacterial
drugs, significantly complicates the diagnosis of the
disease and is the reason for delayed etiotropic
therapy, and also, as a consequence, significantly
increases the risk of complications. .
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