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2, antibiotic therapy
The principles of antibiotic use: site of infection: pyelonephritis should be selected for the high blood concentration of drugs in urine of cystitis should be chosen high concentrations of drugs. Route of infection: sexy man on the upstream, the preferred sulfa drugs. And other systemic symptoms such as fever or is blood-borne infections, more choice of penicillins, aminoglycosides or cephalosporins alone or in combination therapy. According to the results of urine culture and sensitivity test, the clinical efficacy of combined use of antibiotics. drugs in the kidney tissue, urine, blood should have a higher concentration. antimicrobial drug use and strong, broad spectrum antibiotic, the best potent fungicides can be used, and not easy to produce drug-resistant strains of bacteria. small renal dysfunction drugs.
(1) the treatment of symptomatic UTI: A simple UTI, urinary bacterial culture during the later, the preferred initial treatment sulfamethoxazole isoxazole (SMZCo), by SMZ 50mg / (kg.d), TMP 10mg / (kg.d ), is divided into 2 times a day orally for 7 to 10 days. Bacterial culture results to be out of urine test results after the use of antimicrobial drugs susceptibility.
Of the upper urinary tract infection or urinary tract malformation of sick children, after the bacterial culture is generally used during the two antimicrobial agents. Neonates and infants with ampicillin 75 ~ 100mg / (kg.d) IV, plus cefotaxime sodium 50 ~


100mg / (kg.d) intravenously, once a 10 to 14 days after 1 year of age in children with ampicillin 100 ~ 200mg / (kg.d) slow intravenous drip. Course of 10 to 14 days. After the start of treatment should be sent for 3 consecutive days of urine bacterial culture, urine culture if negative conversion after 24 hours, that the effective drugs used, or by urine culture sensitivity test results to adjust medication. 1 week after stopping for a urine culture.
(2) the treatment of asymptomatic bacteriuria: a simple asymptomatic bacteriuria does not require any treatment. However, if urinary tract obstruction, VUR or the presence of other urinary tract abnormalities, or past infection of old scars left by the kidney, it should actively use the antimicrobial treatment. Course of 7 to 14 days, followed by low dose preventive antibiotics until the treatment of urinary tract polarity is up.
(3) the treatment of recurrent UTI: UTI recurrence-free, there are two types, namely, relapse and re-infection. Recurrence of the original infection is to not completely kill the bacteria, in appropriate circumstances re-breeding of bacteria, most patients relapse after completion of radiotherapy occurred within 1 month. Do it again refers to the last time the infection has been cured, this is again by different strains of bacteria or cause UTI. Do it again more common in girls. More in the 6 months after stopping medication occurred.
The treatment of recurrent UTI during the incubation of urine Drama 2 antibiotic therapy chosen a course of 10-14 days would be appropriate, and then to maintain a small dose of drugs to prevent recurrence.
3, active treatment of urinary tract malformations
4, UTI in the local treatment
Often used to treat bladder perfusion liquid, the main treatment of refractory chronic cystitis treated by systemic administration ineffective.(1) pay attention to personal hygiene, do not wear tight-fitting underwear, wash the vulva to prevent bacterial invasion;
(2) to detect and deal with boys phimosis, umbrellas hymen girls, pinworm infection;
(3) timely treatment of urinary tract abnormalities, prevention of urinary tract obstruction and renal scar formation.
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Q & History 1, acute infection(1) newborns with systemic symptoms, and more from the blood infection. Sepsis, jaundice, hidden bacteria in urine, may have fever, body temperature did not rise, pale skin, weight gain, refusal to milk, diarrhea, lethargy and convulsions and so on.(2) early childhood, systemic symptoms and, mainly abdominal pain, diarrhea and vomiting. Crying during urination, the urine odor may be due to frequent urination Erzhi intractable diaper dermatitis, nocturnal enuresis and the emergence of the original without enuresis.(3) children, urinary tract infections to bladder irritation symptoms, upper urinary tract infection with fever, chills, back pain, percussion pain, kidney area, the main rib ridge angle tenderness. E. coli-induced hemorrhagic cystitis may have hematuria.Recurrence of bacteriuria after treatment means being negative, shortly after discontinuation (<6 weeks) pathogens and the resurgence of the original, reproduce the symptoms. Re-infection refers to infection after treatment had been more time, after stopping a long time (usu 6 weeks), by another invasive pathogen causing urinary tract.In the course of more than 6 months. Can be intermittent pyuria or bacteriuria. Long duration may have anemia, fatigue, growth retardation and other symptoms.
(1) General therapy: acute bed rest, drink plenty of water; (2) antimicrobial therapy.Urinary tract infection (UTI) is a direct invasion of urinary tract pathogens, growth and reproduction in the urine, and a violation of urinary tract mucosa caused by injury or tissue, invasion by pathogens in different parts, divided into pyelonephritis, cystitis, urethritis. Upper urinary tract infection, also known as pyelonephritis, cystitis and urethritis together, lower urinary tract infection. Limited because of urinary tract infection in children during a certain part of those few, and is difficult to accurately locate the clinical, Guchang indiscriminately referred to as UTI. Whether the clinical symptoms can be divided into symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria.

According to the 1982 national survey of urinary tract infections account for 8.5% of the diseases in 1987 children in 21 provinces and cities of urine screening examination statistics, UTI urinary tract of children accounted for 12.5% of the disease attacks, whether adults or children, women UTI's incidence rate is generally higher than men, but the early newborn or infant, the male incidence rate than women.Any bacteria can cause UTI, but the vast majority of Gram-negative bacteria such as E. coli, vice E. coli, Proteus, Klebsiella, Pseudomonas aeruginosa, a small number of enterococci and staphylococci. E. coli is the most common pathogens UI. About 60% -80%. Newborns suffering from UTI first of all ages girls and boys under the age of 1, the main pathogenic E. coli is still, more than 1 year old boy in the major pathogens are mostly Proteus. For 10-16 year-old girl, also commonly Staphylococcus, Klebsiella and Enterococcus more common in neonatal UTI.Bacterial pathogenesis of UTI complex internal factors is the host and bacterial pathogen interaction.1, blood-borne infections
Blood of the main ways to attack the road Staphylococcus aureus bacteria.Pathogenic bacteria from the urethra and into the bladder upward, causing cystitis, bladder ureter transitional pathogens and then by the kidneys and cause pyelonephritis, which is the most important way to UTI. Ascending infection caused by bacteria is mainly Escherichia coli, followed by Proteus, or other Enterobacteriaceae, vesicoureteral reflux (VUR) is often a bacterial infection of the direct channel upstream.3, the lymphatic spof infection and direct
Bacteria within the colon and pelvic infection can be infected by lymphatic vessels near the kidney to the surrounding organs and tissues of kidney infection may also permit direct sp.(B) of the host intrinsic factors1, changes in species around the urethra and urinary changes in traits, and breeding for the bacteria to create the conditions for the invasion.
2, bacterial adhesion in urinary tract epithelial cells (colonization) is the proliferation in the urinary tract caused by UTI prerequisite.
3, UTI patients the production of secretory IgA deficiencies, so that the concentration of urinary secretory IgA reduced the opportunity to increase the incidence of UTI.
4, congenital or acquired urinary tract abnormalities, increased risk of urinary tract infection.
5, newborns and young infants poor resistance to infection, susceptibility to UTI. Diapers, often by bacterial contamination urethra, and defense capabilities of local poor, prone to cause ascending infection.
6, diabetes, hypercalcemia, hypertension, chronic kidney disease, sickle cell anemia and long-term application of glucocorticoid or immunosuppressive agents in children, the incidence of UTI can be increased.Diagnostic tests1, urine routine examination and cell count in urine
(1), urine routine examination: such as cleaning in the middle of white blood cells in urine sediment centri 10 / HPF, can be suspected urinary tract infection, hematuria is also common. Pyelonephritis patients with moderate proteinuria, white blood cell casts in urine and morning urine specific gravity and osmotic pressure reduction.
(2) 1 hour excretion of urine for determination of white blood cells, white blood cell c 30 104 / h for the positive, can be suspected urinary tract infection, <20 104 / h for the negative, can be excreted urinary tract infection.Urine culture and colony count of bacteria is the main basis for diagnosis of urinary tract infection. Urine culture is usually that the number of colonies 105/ml can be diagnosed ,104-105 / ml as suspicious, <104/ml Department of pollution, but the results of gender analysis should be combined with sick children have symptoms of bacterial species and the fecundity of the clinical evaluation significance. As a chain containing 3 points of streptococcus bacteria, is generally believed that between colonies can be diagnosed in 103-104/ml by suprapubic bladder puncture urine culture obtained if found to have bacterial growth, which have diagnostic significance. As with severe urinary tract irritation girl, if you have more white blood cells in urine, urine quantitative bacterial culture 102/ml, and the pathogenic E. coli class or saprophytic bacteria, also can be diagnosed as UTI, clinical suspected UTI and a high degree of common bacteria in urine culture negative, should be L-form bacteria and anaerobic training discussion.3, to find bacteria in the urine direct smear method
Oil can be found under microscope, such as a bacterium per field, indicating that the number of bacteria in the u 105/ml or more.4, nitrite dipstick test (Griess test)
E. coli, Escherichia coli and Klebsiella Vice positive for gas production, deformation, green pus, and a weak positive Staphylococcus aureus, Streptococcus faecalis, Mycobacterium tuberculosis was negative. Such as the use morning urine can increase the positive rate.If looking for the flash cells of urinary sediment (sand yellow crystal violet staining) 20000 -4 million / h can be diagnosed, urinary tract infection on neonatal blood cultures can be positive.Aims to:
Check the urinary tract with or without congenital or acquired deformities,
understand the past because of missed diagnosis or inappropriate treatment of chronic kidney damage caused by the progress, or scars,
secondary diagnosis of upper urinary tract infection. Commonly used imaging with B-type ultrasonography, intravenous urography plus CT radiography (check renal scar formation), excretory urography bladder (check VUR), the dynamic and static renal radionuclide imaging, CT scan.

Diagnosis and differential diagnosis Older children and adults the symptoms similar to UTI, urinary tract irritation obvious treatment is often the main complaint. If combined with laboratory tests, can immediately be confirmed. But for infants and young children, especially newborns, the exclusive downtown or absence of obvious irritation, and often systemic manifestations are more prominent, and prone to cause misdiagnosis. Therefore, fever of unknown etiology should be repeatedly mixed children do urine test before treatment with antibiotics for the Li culture, colony count and drug sensitivity test, who has true bacteriuria, that is clean and the middle of quantitative culture or colonies 105ml cocci 103/ml, or suprapubic bladder puncture with bacterial growth in urine culture qualitative, can establish the diagnosis.

In addition to a complete diagnostic evaluation UTI urinary tract bacterial infection, should also include the following:
(1) Department of the beginning of this dye infection, relapse or re-sense;
(2) to determine the type of pathogen, and for drug susceptibility test;
(3) No urinary tract abnormalities such as VUR, urinary tract obstruction, if VUR, but also to further understand the "reverse flow" and whether the severity of renal scar formation;
(4) diagnosis of infection, the upper urinary tract infection or urinary tract infection.

UTI needs and glomerulonephritis, renal tuberculosis and acute urethral syndrome identification. Acute urethral syndrome manifested as urinary frequency, urgency, dysuria, urinary tract irritation, difficulty urinating, but no clean urine culture bacterial growth or meaningless bacteriuria.

Antimicrobial treatment of acute UTI, after reasonable, the majority of symptoms disappeared within a few, such as cure, but nearly 50% of patients may relapse or reinfection. Recurrent urinary tract abnormalities associated with more cases, of which VUR is most common. VUR and renal scarring is closely related to renal scar formation is the prognosis of affected children the most important factor UTI, renal scar formation in the school-age children are most vulnerable, no significant progress after 10 years of age, when renal scarring caused high blood pressure, if they can not be effectively controlled, to the eventual development of chronic renal failure.Treatment aims to control symptoms, eradication of pathogens, removal of predisposing factors, prevention of recurrence.(1) acute need bed rest, to encourage the water to increase urine output in children, mainly girls but also genital hygiene.
(2) to encourage children to eat enough calories supply, rich in protein and vitamins, to enhance the body's resistance.
(3) symptomatic treatment: the high fever, headache, low back pain in children with occipital pain antipyretic agents should be given to relieve symptoms of urinary tract with obvious irritation, can be used atropine, scopolamine and other anticholinergic Mountain drugs or oral sodium bicarbonate of urine. To reduce urinary tract irritation.The principles of antibiotic use: site of infection: pyelonephritis should be selected for the high blood concentration of drugs in urine of cystitis should be chosen high concentrations of drugs. Route of infection: sexy man on the upstream, the preferred sulfa drugs. And other systemic symptoms such as fever or is blood-borne infections, more choice of penicillins, aminoglycosides or cephalosporins alone or in combination therapy. According to the results of urine culture and sensitivity test, the clinical efficacy of combined use of antibiotics. drugs in the kidney tissue, urine, blood should have a higher concentration. antimicrobial drug use and strong, broad spectrum antibiotic, the best potent fungicides can be used, and not easy to produce drug-resistant strains of bacteria. small renal dysfunction drugs.(1) the treatment of symptomatic UTI: A simple UTI, urinary bacterial culture during the later, the preferred initial treatment sulfamethoxazole isoxazole (SMZCo), by SMZ 50mg / (kg.d), TMP 10mg / (kg.d ), is divided into 2 times a day orally for 7 to 10 days. Bacterial culture results to be out of urine test results after the use of antimicrobial drugs susceptibility.

Of the upper urinary tract infection or urinary tract malformation of sick children, after the bacterial culture is generally used during the two antimicrobial agents. Neonates and infants with ampicillin 75 ~ 100mg / (kg.d) IV, plus cefotaxime sodium 50 ~ 100mg / (kg.d) intravenously, once a 10 to 14 days after 1 year of age in children with ampicillin 100 ~ 200mg / (kg.d) slow intravenous drip. Course of 10 to 14 days. After the start of treatment should be sent for 3 consecutive days of urine bacterial culture, urine culture if negative conversion after 24 hours, that the effective drugs used, or by urine culture sensitivity test results to adjust medication. 1 week after stopping for a urine culture.

(2) the treatment of asymptomatic bacteriuria: a simple asymptomatic bacteriuria does not require any treatment. However, if urinary tract obstruction, VUR or the presence of other urinary tract abnormalities, or past infection of old scars left by the kidney, it should actively use the antimicrobial treatment. Course of 7 to 14 days, followed by low dose preventive antibiotics until the treatment of urinary tract polarity is up.

(3) the treatment of recurrent UTI: UTI recurrence-free, there are two types, namely, relapse and re-infection. Recurrence of the original infection is to not completely kill the bacteria, in appropriate circumstances re-breeding of bacteria, most patients relapse after completion of radiotherapy occurred within 1 month. Do it again refers to the last time the infection has been cured, this is again by different strains of bacteria or cause UTI. Do it again more common in girls. More in the 6 months after stopping medication occurred.

The treatment of recurrent UTI during the incubation of urine Drama 2 antibiotic therapy chosen a course of 10-14 days would be appropriate, and then to maintain a small dose of drugs to prevent recurrence.3, active treatment of urinary tract malformationsOften used to treat bladder perfusion liquid, the main treatment of refractory chronic cystitis treated by systemic administration ineffective.UTI prevention include:
(1) pay attention to personal hygiene, do not wear tight-fitting underwear, wash the vulva to prevent bacterial invasion;
(2) to detect and deal with boys phimosis, umbrellas hymen girls, pinworm infection;
(3) timely treatment of urinary tract abnormalities, prevention of urinary tract obstruction and renal scar formation.



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