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Urinary tract infections in infants susceptible to incentives exist, including urinary tract abnormalities and obstruction, immature, indwelling catheter, have not been circumcised. Neonatal nonspecific signs and symptoms. To reduce appetite, diarrhea, stunted growth, vomiting, mild jaundice, lethargy, fever or hypothermia are prompted to urinary tract infection. Bacteria in children as long as there was urinary catheterization per milliliter of bacteria in specimens of more than 1000, either with or asymptomatic cystitis, pyelonephritis, or sepsis, urinary tract infections in children are known. Although colon bacteria often possible contamination through the urethra, but in normal circumstances, the kidney to the bladder between the urinary tract is sterile, sterile to maintain the mechanism of the urinary tract, including the acidity of urine, urine flow patency, a normal urine emptying mechanism, ureteral and urethral sphincter integrity, immunity and the role of mucosal barrier. Any one of these factors have an exception occurs, accompanied by urine sediment, urinary tract infections are a major predisposing factor. Etiology and epidemiology of urinary tract abnormalities can cause many different bacterial infections, but the basic normal urinary tract, pathogenic bacteria are usually the bladder and ureter transitional cell adhesion molecules with specific E. coli. All pediatric age group, 75% of urinary tract infection caused by E. coli more than the rest caused by


the Gram-negative enteric bacteria, particularly Klebsiella, Proteus mirabilis and Pseudomonas aeruginosa. Enterococcus (D group streptococci) and coagulase negative Staphylococcus (eg Staphylococcus saprophytic), is likely to cause this disease the most common Gram-positive bacteria. Mold and urinary tract infections caused by mycobacteria are rare. Adenovirus hemorrhagic cystitis is a syndrome pathogen. Incidence of neonatal urinary tract infection rate of 1% to 2%, male to female ratio was 5:1, male infection is often caused by bacteremia. Urinary tract infections in infants susceptible to incentives exist, including urinary tract abnormalities and obstruction, immature, indwelling catheter, without circumcision; urinary tract infection in neonates 40%, 20% serious kidney abnormalities. Young children after the neonatal period the incidence of urinary tract infection rate of 2% to 5%, 5% school-age children. The ratio of female and male age increased; 4 years 10:1. Women are usually ascending infection, and bacteremia has nothing to do. High incidence of women is considered to be due to the shorter female urethra. This age group susceptible to factors other indwelling catheter, constipation, Hirschsprung's disease and urinary tract anatomical abnormalities (such as obstruction, neurogenic bladder dysfunction, double ureter). Other relevant risk factors for IgA deficiency, diabetes, trauma and sexual intercourse in adolescents. School-age children suffering from urinary tract infections, 5% ~ 15% of the kidney associated with need for surgical correction of deformity; 30% to 40% had vesicoureteral reflux, need to use antibiotics to prevent infection. Onset of urinary tract infection in children in the incidence of reflux is inversely proportional to age. Neonatal signs and symptoms of nonspecific symptoms and signs, exactly like neonatal sepsis. To reduce appetite, diarrhea, stunted growth, vomiting, mild jaundice, lethargy, fever or hypothermia are prompted to urinary tract infection. Local signs of infant less, some children with asymptomatic, only discovered in routine testing; other children with gastrointestinal symptoms (such as vomiting, diarrhea or abdominal pain). 2 Although there are more children over the age of cystitis or pyelonephritis typical performance, but up to 40% of the urinary tract infection may be asymptomatic. Symptoms of cystitis include dysuria, urinary frequency, hematuria, urinary retention, suprapubic pain, urinary urgency, itching, urinary incontinence, Niaowei bad information and enuresis. The symptoms of pyelonephritis cystitis symptoms plus fever, chills, pain and percussion pain kidney area. Diagnosis of urinary tract infection diagnosis required sterile urine was collected and cultured to confirm. If urine is obtained from suprapubic puncture, and urine of any gram-negative bacteria, or with coagulase negative Staphyloco 1000/ml Jieyou diagnosis. Specimens obtained by catheter, the colony c 103 / ml is generally significant. Discharge of clean urine male colony c 104 / ml, fe 105 / ml were significant. Urine samples collected is not reliable, it should not be used to diagnose urinary tract infection, urinary tract infection in children of all suspected, should check whether the abdominal mass, enlarged kidneys, urinary tract malformation, rib tenderness, and the next part of the ridge angle signs of spinal deformity. Obstruction of urine flow into nerve weakness may be the only clue bladder. Blood pressure, height and body weight should be recorded, hematocrit, plasma urea nitrogen and creatinine concentrations should also be determined. Urine microscopy useful, but not precise enough. Pyuria (urine sediment in the centrifuge of every high power field, see more than 5 white blood cells) indicates a urinary tract infection, urine culture in urinary tract infection confirmed that 60% had no microscopic pyuria. Gram stain of urine is to identify urinary tract infection may be a sensitive method. Urine without centrifugation mirror of each oil (1000X) in a centrifuge urine sediment bacteria or increased slightly in each of more than 10 white blood cells, indicating that the number of bacteria in urine cul 105 / ml. Chemical tests of chemical examination methods come with bacteria (such as nitrite test and leukocyte esterase test) only for screening purposes, but the fresh discharge of urine if nitrite test was positive, highly suggestive of urinary tract infection. Urine culture Urine culture as soon as possible; if the delay is expected to be 10 to 20 minutes, should be stored at 4 refrigerator. Urine is best seeded in blood agar plate, incubated at 37 for 24 to 48 hours. Obtained by quantitative bacterial ring crossed the blood agar plate. If the urine from the suprapubic puncture or bladder catheterization, should be respectively 0. 001ml and 0. 1ml for culture. Urine bag or clean exhaust collected urine specimens with a 0. 001ml for culture. Bacteriology staff, should be selected blood agar plates, despite the kit method (such as slide method or the filter paper method) is sensitive. There is sometimes urinary tract infection, but colony count is very low, which may have been treated with antibiotics, the urine is extremely (specific gravity <1.003), severe infections or urinary obstruction's sake. Repeat training can improve its accuracy. On the urinary tract and lower urinary tract infection on the identification test with lower urinary tract urinary tract infection is sometimes difficult to identify. If children have high fever, pain in kidney area knocking a large number of pyuria accompanied by tube, then the diagnosis of pyelonephritis can be determined. However, more sensitive diagnostic techniques (such as bladder irrigation, determination of antibody concentration Check capacity of the bacteria-coated) have been used in clinical studies. Many asymptomatic or only cystitis symptoms in children proved to be the urinary tract infection. In clinical conditions generally do not have these specialized inspection. All images are diagnosed with urinary tract urinary tract infection in children should be subject to ultrasound, radionuclide scan or IVP to identify serious defects; excretory bladder and urethra can be found in significant contrast reflux, 20% to 50 % occurred in children with urinary tract infection urine reflux. Flow of urine up the anti-infection or obstruction of the renal pelvis above the retention area, can lead to chronic pyelonephritis, renal scarring, renal dysplasia and renal failure. Intravenous urography or ultrasound may at any time, but infants are advocated in the diagnosis within a week. Excretion of urinary bladder is best delayed imaging 3 to 6 weeks to allow the temporary cystitis caused by reflux recovery and accurate assessment of the responsiveness of ureter and bladder flap. Some doctors advocate the girls over 3 years old, the best urinary tract infection in the second after the radiological examination. Excretory bladder urethrography (VCUG) is the best diagnosis of ureterovesical reflux anatomical imaging technologies, applications for radionuclide technetium 99m imaging bladder and urethra, its only VCUG1% of the radioactive gonadal function; the diagnosis of urinary tract against the technology flow is very sensitive, it can be used in the initial inspection. When the bladder and urethra radiological imaging or radionuclide angiography showed no reflux, the renal ultrasound can be used to exclude anatomical abnormalities; when there is reflux, the intravenous urography (IVU) is the best way to diagnose the urethra, or Application cortex indicator (such as 99m Tc grapes heptose acid) for renal radionuclide scan for diagnosis of renal scarring when compared with IVU less radiation damage, and very sensitive. Ultrasound in the diagnosis of reflux in children with urinary tract can be developed as a follow-up observation of the kidney checks. Vesicoureteral reflux (VUR) urinary reflux according to international research for processing stages identified by the Commission: a: reflux into ureter only affect the second phase: to reach calyceal reflux three phases: Phase IV expansion of a ureter and renal pelvis : expansion of the ureter and renal pelvis increased, dome disappearance of five acute angle: the ureter, renal pelvis and calyx serious expansion of the nipple pressure trace disappeared treatment and prognosis of urinary tract infection prognosis is usually good. Unless accompanied by urinary tract abnormalities, or rarely may progress to renal failure, symptomatic and asymptomatic urinary tract infection recurrence rate was 50%, with urinary tract abnormalities are a greater risk of relapse. The main goal of treatment is to maintain kidney function and reduce the acute mortality. The newborn, in the blood and urine culture samples collected immediately after use by the parenteral ampicillin and aminoglycoside treatment means, on the appropriate dose given in neonatal sepsis. If the blood culture was negative, the treatment effect, and 48 to 72 hours after treatment urine cultures were negative again, can be changed to oral antibiotics (such as ampicillin, amoxicillin, cephalosporins such as selection based on sensitivity), treatment of 10 days. In the treatment of 7 to 10 days after the end of a urine culture again. Poor treatment that bacterial resistance to antibiotics or obstructive damage, the need for timely inspection. After the neonatal period in children suffering from urinary tract infections, oral antibiotics, but if high fever, poisoning symptoms significant or vomiting, can be parenteral administration of law. An alternative antibiotic started ampicillin, amoxicillin, sulfa yl dimethyl different , trimethoprim / sulfamethoxazole (TMP-SMX) or a cephalosporin. These agents kill enough of the role of E. coli. Change of treatment should be based on culture and sensitivity test results. Suffering from acute pyelonephritis, and hospitalization in children with sepsis should be consolidated through the application of parenteral ampicillin and a way to aminoglycosides, or 3rd generation cephalosporins such as cefotaxime sodium, ceftriaxone, although many do not Complications associated with larger short children with a shorter treatment can be cured, but it is generally believed that the treatment of urinary tract infection 7 to 10 days. If you start 2 to 3 days after treatment did not show efficacy of urine culture should be repeated for all the children suffering from urinary tract infection after discontinuation of antibiotics, cultured again from 7 to 10 days to observe the effect. In the 48 hours after starting antibiotic treatment of bacteria in urine is still suggestive of resistant bacteria, there is obstruction or serious complications. As the disease easy to relapse, it should be within one year after the diagnosis of 3 to 4 times repeated urine culture, the first 2 years to 3 years (or symptoms of urinary tract infections in children occur at any time) for at least 2 times a urine culture. For two or more reflux in children two to reduce relapse and prevention of kidney damage, may give 2mg/kg or nitrofurantoin daily TMP / SMX (TMP daily 2mg/kg), 1 day, usually evening use. Ureterovesical reflux in children should be based on degree of regurgitation (see above diagnosis) to give treatment. Radiological examination of normal or mild changes and one of vesicoureteral reflux only for regular urine culture; II or III reflux in infants may consider the use of antibiotics to prevent infection; for four or five or discovered reflux have severe kidney abnormalities, should be transferred to the regular urology treatment and may need surgery.



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