Signs of a urinary tract infection in a child. Treatment of UTI in children. Symptoms of urinary tract infection in children

– microbial group inflammatory diseases organs urinary system: kidneys, ureters, bladder, urethra. Depending on the location of the inflammation, urinary tract infection in children can manifest as dysuric disorders, pain in the bladder or lower back, leukocyturia and bacteriuria, and temperature reaction. Examination of children with suspected urinary tract infection includes urine tests (general, culture), ultrasound of the urinary system, cystoureterography, excretory urography, cystoscopy. The basis for the treatment of urinary tract infections in children is the prescription of antimicrobial drugs and uroantiseptics.

General information

Urinary tract infection in children – general concept, denoting inflammatory processes in various departments urinary tract: infections of the upper urinary tract (pyelitis, pyelonephritis, ureteritis) and lower urinary tract (cystitis, urethritis). Urinary tract infections are extremely common in childhood - by age 5, 1-2% of boys and 8% of girls have had at least one episode of the disease. The prevalence of urinary tract infections depends on age and gender: for example, among newborns and infants Boys are more often affected, and girls between the ages of 2 and 15 years old. Most often in the practice of pediatric urology and pediatrics one has to deal with cystitis, pyelonephritis and asymptomatic bacteriuria.

Causes of urinary tract infection in children

Spectrum of microbial flora, causing infection urinary tract in children, depends on the sex and age of the child, conditions of infection, the state of intestinal microbiocenosis and general immunity. Overall among bacterial pathogens Enterobacteriaceae are in the lead, primarily coli(50-90%). In other cases, Klebsiella, Proteus, enterococci, Pseudomonas aeruginosa, staphylococci, streptococci, etc. are sown. Acute infections urinary tract infections in children are usually caused by one type of microorganism, however, with frequent relapses and malformations of the urinary system, microbial associations are often detected.

Urinary tract infections in children can be associated with urogenital chlamydia, mycoplasmosis and ureaplasmosis and combined with vulvitis, vulvovaginitis, balanoposthitis. Fungal infections urinary tract infections often occur in weakened children: premature infants, those suffering from malnutrition, immunodeficiency conditions, and anemia. There is an assumption that viral infection(infection with Coxsackie viruses, influenza, adenoviruses, herpes simplex virus types I and II, cytomegalovirus) acts as a factor contributing to the accumulation of bacterial infection.

Conditions accompanied by impaired urodynamics predispose to the development of urinary tract infections in children: neurogenic bladder, urolithiasis, bladder diverticula, vesicoureteral reflux, pyeelectasia, hydronephrosis, polycystic kidney disease, renal dystopia, ureterocele, phimosis in boys, synechia of the labia in girls. Often, urinary tract infections in children develop against the background of gastrointestinal diseases - dysbiosis, constipation, colitis, intestinal infections etc. Metabolic disorders (dysmetabolic nephropathy in children, glycosuria, etc.) may be a risk factor.

Infection can be introduced into the urinary tract due to insufficient hygiene of the external genitalia, improper technique of washing the child, through the lymphogenous and hematogenous routes, and during medical procedures (bladder catheterization). Boys who have been circumcised suffer from urinary tract infections 4-10 times less often than uncircumcised boys.

Classification

Infections are classified according to the location of the inflammatory process upper sections urinary tract - kidneys (pyelonephritis, pyelitis), ureters (ureteritis) and lower sections- bladder (cystitis) and urethra (urethritis).

According to the period of the disease, urinary tract infections in children are divided into the first episode (debut) and relapse. The course of recurrent urinary tract infection in children can be maintained by unresolved infection, persistence of the pathogen, or reinfection.

By severity clinical symptoms distinguish between mild and severe urinary tract infections in children. In mild cases, the temperature reaction is moderate, dehydration is insignificant, and the child complies with the treatment regimen. Severe urinary tract infections in children are accompanied by high fever, persistent vomiting, severe dehydration, sepsis.

Symptoms in children

Clinical manifestations of urinary tract infection in a child depend on the localization of the microbial inflammatory process, the period and severity of the disease. Let's look at the signs of the most common urinary tract infections in children - pyelonephritis, cystitis and asymptomatic bacteriuria.

Pyelonephritis in children occurs with febrile temperature (38-38.5°C), chills, symptoms of intoxication (lethargy, pallor skin, loss of appetite, headache). At the height of intoxication, frequent regurgitation, vomiting, diarrhea, neurotoxicosis, and meningeal symptoms may develop. The child is bothered by pain in lumbar region or stomach; the tingling symptom is positive. IN early age infections of the upper urinary tract in children can be hidden under the guise of pylorospasm, dyspeptic disorders, acute abdomen, intestinal syndrome, etc.; in older children – influenza-like syndrome.

Treatment of urinary tract infections in children

The main place in the treatment of urinary tract infections in children belongs to antibacterial therapy. Before a bacteriological diagnosis is established, initial antibiotic therapy is prescribed on an empirical basis. Currently, in the treatment of urinary tract infections in children, preference is given to inhibitor-protected penicillins (amoxicillin), aminoglycosides (amikacin), cephalosporins (cefotaxime, ceftriaxone), carbapenems (meropenem, imipenem), uroantiseptics (nitrofurantoin, furazidin). The duration of the course of antimicrobial therapy should be 7-14 days. After completion of the course of treatment, repeated laboratory examination child.

Vaccination of children is carried out during periods of clinical and laboratory remission.

Primary prevention of urinary tract infections in children should include instilling proper hygiene skills, sanitizing chronic foci of infection, and eliminating risk factors.

Children can also get a genitourinary tract infection because inflammation can be caused by improper care behind the baby or the penetration of the pathogen into his body.

Urogenital infections in children manifest themselves in different ways, since the symptoms depend on the form of damage to this system. The cause of the pathology is infectious and non-infectious factors, as well as infection of the mother’s reproductive tract during pregnancy. To establish a diagnosis and select the correct treatment methods, you need to do a series of tests and undergo an examination.

Microbial-inflammatory diseases occur at any age. Infections of the genitourinary system are more common in girls. The reason for this is the location of the entrance to the vagina next to the anus, which shortens the path of some pathogens from the intestines to the urinary canals.

Due to the fact that the urethra connects to one of the areas reproductive organs, then over time even infants develop concomitant sexually transmitted infections. These are vulvovaginitis, balanoposthitis, vulvitis, and similar inflammations. Pathogenic pathogens affect the mucous membranes of the genital tract and organs, and doctors associate the infection itself with mycoplasmosis, chlamydia and

Forms of urine diseases excretory system in children:

• pyelonephritis;
• cystitis;
• urethritis.

In pyelonephritis, bacteria affect kidney tissue and the pyelocalyceal system. The disease can be primary acute and chronic, as well as secondary, which develops against the background of other pathologies.

Inflammation of the inner mucous membrane of the bladder is called cystitis. The infection comes in acute and chronic forms. With urethritis, the inflammatory focus is localized in the walls of the urethral canal. The disease occurs more often in boys. The form can be acute, chronic and total, when all parts of the urethra are affected, including the neck of the bladder.

Causes of genitourinary infections in children

The causative agents of diseases are ureplasma, mycoplasma, trichomonas, enterobacteria, viruses (herpes and other types), gonococci, staphylococci, streptococci, fungi, Proteus, E. coli, Klebsiella. IN genitourinary system The pathogen enters the child through the blood, lymph or through the external genitalia.

If a woman becomes infected with type II herpes or another pathogen during pregnancy, the infection can enter the child’s body through the placenta or during birth.

Inflammation in a child also begins against the background of congestion in the pelvic area, allergies, vesicoureteral reflux, impaired urinary tract motility in infants and older children, kidney or gastrointestinal diseases. TO pathological reasons also include abnormal development of fetal organs during a woman’s pregnancy.

Indirect causes of genitourinary infections:

• hypothermia;
• trauma to the urethral membrane (burn, passage of stones or sand from the kidneys, bladder, instrumental examination of the canal, insertion of a catheter, etc.);
• decreased immunity;
• helminthic infestation;
• heredity;
• prematurity;
• by-effect medicines;
• irregular personal hygiene procedures.

Babies are more susceptible to infection if they are weakened by respiratory and digestive system or during pregnancy, the mother suffered from ARVI, influenza, or GVI.

General symptoms

Among common features inflammation in the baby is described as restlessness, crying for no reason, uncharacteristic movements when urinating, worsening general well-being, loss of appetite, sleep disturbance. Otherwise, the symptoms of urinary system infections in children are similar to the clinical picture of the disease in adults.

Characteristic signs of the disease

Pyelonephritis is accompanied by intoxication, chills, temperature above 38 C, pale skin, pain in the head, abdomen and lower back, digestive system dysfunction, frequent regurgitation or vomiting, diarrhea. Signs of neurotoxicosis may also occur:

• excitement;
• convulsions;
• dysfunction of the thermoregulation mechanism (hyperthermia).

With cystitis in infants, symptoms such as crying and writhing of the body during urination, a temperature above 38 ° C, retention, cloudy urine and the appearance of blood or sediment in the fluid. Older kids tell or show that it hurts in the lower abdomen, he wets himself because he cannot hold back.

Other dysuric disorders include a small volume of urine, muscle tension in the suprapubic area, and incomplete emptying of the bladder.

With urethritis there is no intoxication and no increase in temperature. When inflamed, the urogenital membranes swell, begin to itch, pain appears during urination, and there is blood in the urine. Later it is released from the urethra white mucus or pus. Girls complain of pain in the lower abdomen. Acute form urethritis is accompanied by vasodilation, fragmented damage to the urethral wall or tissue death. Chronic inflammation leads to a narrowing of the lumen of the urethra and canal.

Diagnosis of genitourinary infections

To confirm the pathology, you need to do an ultrasound of the genital organs, kidneys, bladder, and donate blood and urine for a general analysis. Before collecting urine, the baby is washed and wiped dry. Parents can download a lesson on the topic “How to properly collect urine from a child to diagnose genitourinary infections in ppt format so that the results are reliable.”

Laboratory urine tests:

• Zimnitsky's test;
• according to Nechiporenko;
• bacterial sowing on flora;
• antibiogram;
• biochemical.

The results of a general urine test show an increase in leukocytes by more than 50%, the presence of ppt (precipitate - sediment). Leukocytosis, accelerated ESR, and possible anemia are detected in the blood. Additionally, they may be referred for urethroscopy, urethrography, or voiding cystoscopy.

Treatment of genitourinary infections in children

Therapy is carried out with antibiotics Cefepime, Cefuroxime, Cefoperazone and other cephalosporins of I-IV generations. However, Ceftriaxone has a side effect - the medicine can cause jaundice. The attending physician may also prescribe a combination of drugs or substances Ampicillin/Sulbactam, Ampicillin with aminoglycosides (Amikacin, Gentamicin), Amoxicillin/Clavulanate, Co-trimoxazole.

At genitourinary infections uroantiseptics Nitrofurantoin, Furamag and other nitrofurants, Canephron are used. The doctor also prescribes nonsteroidal anti-inflammatory drugs, such as ibuprofen, and antihistamines Loratadine, Clemastine, and other desensitizing medications to reduce severe symptomatic manifestations.

At chronic urethritis They also prescribe immunostimulating drugs, enzyme and absorbent agents, apply physiotherapy, local therapy by injecting drugs into the canal.

If the child has no contraindications to taking herbal medicines, he is given a urological preparation, tea from lingonberry leaves, and sage decoction. Infusions of mint, linden and elderberry flowers, and rose hips are taken as anti-inflammatory drinks.

Conservative therapy for genitourinary infections is recommended to be combined with physiotherapy and methods traditional medicine. This dry heat on the lower abdomen, electrophoresis, UHF, sitz baths with a decoction of chamomile, string, calendula and sage. The water temperature should be 37° C, and the procedure should last 15 minutes.

For genitourinary infections, foods that irritate the gastrointestinal tract should be excluded from the diet: spicy, salty, sour foods, spices. It is advisable to double the daily volume of fluid consumed (still water, compotes, fruit drinks), which will improve the process of washing out the pathogen from the urinary apparatus.

After recovery, it is recommended to take a control urine sample every month for a general analysis (3-6 times). If the disease appears more than 2-3 times, the child should have additional examination for the presence of other pathologies against which the infection develops.

Conclusion

Lesson for parents: the best prevention genitourinary diseases A child is considered to regularly maintain cleanliness of his body and use children's hygiene products. To exclude inflammation of the membranes in newborns, women need to be examined, and possibly treated, even before conception. During pregnancy, it is recommended to visit the office of a gynecologist-obstetrician in a timely manner and not to be zealous in using the products. intimate hygiene so as not to provoke inflammation.

Children suffer from illnesses associated with urinary tract infections quite often. According to statistics, up to 2% of boys and up to 8% of girls who have reached the age of five already have at least one case of this kind in their history. If you apply in a timely manner medical care Treatment of urinary tract infections in children usually ends successfully, but ignoring the problem is fraught with very unpleasant complications.

Reasons for the development of the pathological process

Fluids found in the organs of the excretory system healthy person(kidneys, ureters, bladder and urethra), are sterile. Pathogenic microorganisms can enter them in one of two ways: with the bloodstream (from an inflammatory focus in other organs) or from the outside (if the rules of intimate hygiene are not followed or medical procedures are performed involving the insertion of instruments into the urethra or bladder).

Additional risk factors for developing urinary tract infections in children are:

• Gender of the child. Due to the peculiarities of the anatomy (the presence of a short and wide urethra), girls get UTIs more often than boys;
• Early age. Girls under 4 years of age and boys under 1 year of age are most susceptible to infection;
• Congenital anomalies of the excretory and reproductive tract;
• Low immunity, tendency to catch colds, frequent inflammatory diseases (otitis, stomatitis, rhinitis, etc.);
• The presence of any ailments and developmental defects that provoke stagnation of urine: urolithiasis disease, phimosis in boys, synechia in girls, vesicoureteral reflux and many others;
• Diseases gastrointestinal tract(colitis, dysbacteriosis, etc.);
• Family history of chronic UTIs.

The causative agent of urinary tract infections in children is most often Escherichia coli (up to 90% of all cases), less often Pseudomonas aeruginosa and Clepsiella. Infection with streptococci, mycoplasma and chlamydia sometimes occurs.

Symptoms of urinary tract infections in children

Signs of a UTI depend on the child's age. The little ones become capricious, lose their appetite, and stop gaining weight. Sometimes infants experience diarrhea or vomiting. However, it is not uncommon for the only symptom of a urinary tract infection in children under two years of age to be elevated temperature bodies.

In older children, the signs of infection are more pronounced. Among them:

• Pain in the lumbar region or lower abdomen;
• Unpleasant burning sensation when urinating;
• Frequent urge to urinate with minimal release of fluid;
• Change in the appearance of urine (turbidity, appearance of flakes, mucus, streaks of blood);
• Increased body temperature, chills, weakness;

Urinary tract infections in children develop very quickly, especially with the so-called ascending type of infection. This means that untreated urethritis can turn into cystitis and pyelonephritis within a few days. Therefore, the presence of any of the described symptoms is a reason to urgently consult a doctor.

Diagnosis and treatment of urinary tract infections in children

If a UTI is suspected, it is necessary to quickly determine what exactly the child is sick with and prescribe a course of antibiotics. There are two problems in this case. Firstly, the symptoms of urinary tract infections in children are similar to those of many other diseases (vulvovaginitis, belanitis, orchitis, etc.); discomfort during urination may occur due to infection with worms (pinworms). Secondly, in case of UTI, it is very important to determine the causative agent of the disease, since the success of treatment directly depends on the selection of a specific antibiotic. In addition, a disease such as urethritis may also have a non-infectious origin (for example, develop when exposed to urethra detergents). In such cases drug therapy not required.

To diagnose UTIs, the following are used:

• Laboratory tests of blood and urine. It is necessary to conduct a urine culture to determine the causative agent. Add to list free services this study is not included, but it allows you to prescribe the most effective treatment and avoid long-term use antibiotics wide range actions. If the doctor himself does not offer to do this test, parents should find out about this possibility or send a sample of the child’s urine for culture to a paid institution;
• Visualizing (ultrasound and radiographic) procedures that allow a specialist to assess the condition of the organs of the excretory system and identify the presence of birth defects development, etc. These methods are used only in cases where the disease is recurrent or its treatment is delayed.

It is important to know the following: many diagnostic procedures are painful. A doctor often prescribes tests based on the fact that they are included in the list of insurance services (an example is cystoscopy - an extremely unpleasant and uninformative method). Before agreeing to a doctor-recommended procedure, parents should learn as much as possible about its effectiveness and alternative diagnostic options.

Treatment of urinary tract infections in children, as a rule, comes down to a course of treatment antibacterial agents(tablets or suspensions). At correct selection With the drug, symptoms begin to disappear within a day or two after the start of therapy. The child must be provided with adequate light food, drinking plenty of fluids and semi-bed rest. Hospitalization is required only in cases where the baby cannot take antibiotics or has severe chronic illnesses. The condition of children who have recovered from the disease must be monitored, since the disease relapses in 30% of cases.

Prevention of UTIs should include careful daily toileting of the external genitalia (it is the urethra that in most cases serves as the “entry gate” for infection). Contrary to popular belief, decoctions medicinal plants that have a diuretic effect (bearberry, knotweed, lingonberry leaves, etc.) do not prevent infection and do not have a noticeable effect therapeutic effect. Clinically proven preventive action cranberry juice: it is useful to give it to children under 6 years old, 150 ml per day, and to older children, 300-400 ml (in two or three doses).

UTIs in children can be successfully treated and avoided unpleasant consequences only if you seek medical help in a timely manner. Self-medication or interruption of the course of prescribed antibiotics can lead to repeated relapses, deterioration of the condition of the excretory system and a sharp decrease in the child’s quality of life.

Text: Emma Murga

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Urinary tract infection (UTI) is a generalized name for inflammatory diseases of the urinary system. The concept includes urethritis,. UTI ranks second in incidence after inflammation of the respiratory system. In childhood this pathology is also common, but its diagnosis is difficult due to the inability to make complaints and frequent disguise as other diseases (ARI,).

information During the first year of life, boys suffer from inflammation of the urinary system more often, which is associated with the presence congenital anomalies, and after a year the ratio changes 6:1 towards an increase in this pathology among girls.

This is explained by the fact that anatomically the urethra in the female sex is located closer to the anus, therefore, pathogenic microflora It is easier for their intestines to enter the urethra and then into the urinary system.

Classification

UTIs can be divided into infections based on localization:

• upper sections ();
• lower sections(and urethritis).

According to the duration of the disease:

• acute(less than 3 months);
• chronic(more than 3 months).

According to the presence of complications:

• uncomplicated;
• complicated.

Causes of infection and risk factors

The direct cause of inflammation in the urinary system is bacteria. The most common pathogens are:

• coli;
• proteas;
• Klebsiella;
• pseudomonas;
• enterococci and others.

information However, for the development of the disease, the presence of bacteria is not enough; a combination of risk factors, the predisposition of the person himself, and a decrease in immune defense are necessary.

To the main risk factors in children include:

• complicated pregnancy in the mother ( chronic pyelonephritis, gestosis, occupational hazards in the mother during pregnancy, hereditary history and others);
• decreased general and local immunity;
• malformations of the urinary system;
• violation of the outflow of urine (presence of stones, developmental anomalies, vesicoureteral-renal reflux);
• metabolic diseases () and others.

Symptoms of UTI in children

For infection in the lower sections comes to the fore pain syndrome. Older children complain of pain when urinating, frequent urination, discomfort in the abdomen, above the pubis. General symptoms may also occur:

• weakness, lethargy;
• temperature increase;
• decreased appetite.

At acute pyelonephritis the pain syndrome is less pronounced. Symptoms of intoxication come to the fore:

• lethargy, weakness, fatigue;
• sleep disturbance;
• increase in body temperature.

The pain syndrome is localized in the lumbar region. When it is severe, children can take a forced position (lying on their side with their legs brought to the body), when it is weak, pain is felt when touching the lower back.

Chronic pyelonephritis More often it manifests itself as a periodic rise in temperature, pain in the lower back. Children become irritable, lethargic, and get tired quickly. With a long course, a lag in physical and mental development is possible.

UTIs in children under one year of age manifest as intoxication syndrome. It can often be disguised as other diseases (ARI, intestinal colic, ). The child becomes restless and capricious.

Diagnosis of urinary tract infection in children

For older children, the main criteria for diagnosing UTIs are the complaints presented.

important In children, inflammation of the urinary system is more often diagnosed by the presence indirect signs(fever, crying or visible discomfort when urinating, vomiting, diarrhea and others).

Basic diagnostic methods:

1. – the simplest and most informative. At inflammatory process leukocytes appear in the urine, possibly the presence of protein, and bacteria.
2. Urine culture followed by determination of the pathogen and its sensitivity to antibiotics- more informative, but requires some time and money. It makes it possible not only to accurately determine the cause of inflammation, but also helps to more accurately select treatment.
3. Urinalysis according to Nechiporenko - another test to detect inflammation in the urinary tract. With its help you can more accurately (compared to general analysis urine) estimate the number of red blood cells in 1 ml of urine.
4. Ultrasound of the kidneys and pelvic system – most often used in children instrumental method. If the pyelocaliceal system is dilated, this indicates pyelonephritis.

Treatment

Treatment for UTIs should begin as soon as the diagnosis is confirmed. The main treatment is antibiotic therapy. Important role also has a diet regimen.

Drug therapy

For the first episode of uncomplicated infection Most often, antibiotics from the group of protected penicillins are prescribed in the form of tablets, suspensions, capsules, syrup or 2-3 generation cephalosporins, also in oral form. Most common medications:

• Augmentin;
• Amoxiclav;
• Cefix;
• Cefaclor;
• Cefuroxime.

The duration of therapy for infections of the lower sections is 5 days, and for pyelonephritis it increases to 10.

Good effect have uroantiseptics (Furamag, Furagin and others).

For chronic UTI can be prescribed for a long time herbal preparations, having anti-inflammatory, diuretic, antibacterial effects, such as Canephron and phytolysin ointment.

dangerous Chronic pyelonephritis requires longer and more serious treatment. In some cases, it should be carried out in a hospital (severe form, severe intoxication syndrome, early childhood).

Diet and regimen

Diet and drinking regime allows you to speed up the healing process and prevent new episodes of infection:

• Sour, fried, spicy, salty foods should be excluded.
• It is important to drink plenty of fluids. This helps flush out the infection from urinary system, does not allow bacteria to linger and multiply. Fruit drinks made from cranberries, lingonberries, kidney teas, and decoctions have a good effect. medicinal herbs(chamomile, birch, St. John's wort and others).

Preventing urinary tract infections in children

Basic principles of UTI prevention:

• Explain to your child that holding back (tolerating) urination is harmful. This creates a favorable background for the proliferation of bacteria.
• If the child already goes to the toilet and serves himself, explain how to wipe his butt correctly and monitor this action.
• If the child is still small, change the diaper in a timely manner and wash the bottom correctly (from front to back).
• Dress your child according to the weather, especially pay attention to the crotch area, lower back and legs.
• Make sure that your baby does not sit in a cold place, even in hot weather.
• Your child needs to drink enough throughout the day. Be it simple drinking water or juices, compotes and fruit drinks.
• If the child is suffering chronic infection urinary system, it is necessary to periodically carry out preventive courses of uroantiseptics.
• It is necessary to take regular tests, since UTIs (especially in the upper sections and chronic forms) can occur without obvious signs.