E. coli Enterococcus. urinary tract infection UTI UTI UTI WBC/HPF CRP UTI UTI UTI. vesicoureteral reflux VUR

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1 Vol No CRP p E. coli Enterococcus Characteristics of Children with Upper Urinary Tract Infection Having no Pyuria Takahisa Kimata Yuka Isozaki Minoru Kino Kazunari Kaneko Nakano Children s Hospital Department of Pediatrics, Kansai Medical University School of Medicine urinary tract infection UTI UTI UTI WBC/HPF UTI UTI UTI UTI vesicoureteral reflux VUR UTI Key words E. coli Enterococcus

2 Vol No A B P value NS NS NS NS A B Mann-Whitney U χ P µ NS A CRP NS B mg/d NS NS UTI A NS : not significant, CRP : c- reactive protein B UTI /ml A B A B A / µlb /µl C-reactive protein WBC/HPF A mg/db mg/ A B VUR : vesicoureteral reflux.

3 Vol No grade A B VUR grade d A B A B A B voiding cystourethorgraphyvcug A VCUG VUR B VCUG VUR VUR p VUR grade A B VUR VUR grade VUR A B p VUR UTI m TC- DMSA A B p A B A E. coli Enterococcus Klebsiella B Enterococcus E. coli A E. coli B Enterococcus p UTI UTI UTI UTI

4 Vol No A B GBS : group B streptococcus. UTI VUR UTI UTI UTI UTI UTI UTI A B E. coli Enterococcus UTI E. coli UTI Enterococcus UTI E. coli UTI Enterococcus Enterococcus UTI p UTI E. coli P α α UTI Enterococcus

5 Vol No βmicroglobulin NAGNacetyl-β-D-glucosaminidaseLDHLactate Dehydrogenase A B UTI UTI Enterococcus UTI UTI UTI UTI VUR UTI UTI VUR UTI UTI American Academy of Pediatrics. Committee on Quality Improvement : Subcommittee on Urinary Tract Infection. Practice parameter : the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103 : , p Kramer MS, Tange SM, Drummond KN, Mills EL. : Urine testing in young febrile children : a risk-benefit analysis. J Pediatr 125 : 613, p Downs SM : Technical report : Urinary tract infections in febrile infants and young children. Pediatrics 103 : e54, Hansson S, Brandstrom P, Jodal U, Larsson P : Low bacterial counts in infants with urinary tract infecyion. J Pediatr 132 : , Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. : International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol. 15 : , Kunin C : Urinary tract infections : Detection, prevention and management. 5th ed, Baltimore, Williams & Wilkins : 419, Vaisanen V, Elo j, Tallgren LG, et al. : Mannose-resistant haemagglutination and Pantigen recognition are characteristic of Escherichia coli causing primary pyelonephritis. Lancet 2 : , Seno Y, Kariyama R, Mituhata R, Monden K, Kumon H : Clinical Implications of Biofilm Formation by Enterococcus feacalis in the Urinary Tract. Acta Medica Okayama 59 : 7987, BACTERIAL AD- HERENCE & BIOFILM Enterococcus feacalis BACTERIAL ADHER- ENCE & BIOFILM Master Lecture minimum requirements p

6 Vol No Characteristics of Children with Upper Urinary Tract Infection Having no Pyuria Nakano Children s Hospital Department of Pediatrics, Kansai Medical University School of Medicine Takahisa Kimata, Yuka Isozaki,MinoruKino, Kazunari Kaneko Background : Though a diagnosis of urinary tract infection (UTI) should be made by the confirmation of significant bacteriuria, the presence of pyuria which can be examined by microscopic analysis using urine sediment leads us to have a high index of suspicion for UTI in children. Recently, we encountered several children with upper UTI having no pyuria. Aims : To characterize the children with upper UTI having no pyuria. Subjects and Methods : Retrospective analysis using medical record was performed in 129 children (male/female 88/41, median age 4.12 mo.) with upper UTI admitted to our hospital during 2004 and These children were classified into 2 groups according to the presence of pyuria : group A, children with upper UTI having pyuria, group B, children with upper UTI having no pyuria. Significant pyuria was defined as more than 4 leukocytes in the urine sediment per high power field under light microscopy. Age (mo.), sex ratio (male/female), time from the onset of pyrexia to urine sampling (hours), maximum body temperature (C), maximum white blood cell count (WBC) in the peripheral blood (per ml), maximum serum level of c- reactive protein (CRP, mg/dl) during the course of illness were compared between groups. Furthermore, the prevalence of vesicoureteral reflux (VUR) in both groups was also analyzed. Results : Among 129 children with upper UTI, 111 had significant pyuria (86%, group A) while 18 children did not (14%, group B). There were no significant differences between group A and group B in age, sex ratio, time from the onset of pyrexia to urine sampling, maximum body temperature, maximum WBC count, maximum serum level of CRP and the prevalence of VUR. Interestingly enough, there was a difference in the most frequently detected causative pathogen between group A and group B : E.coli was detected in 90 out of 111 (81%) in group A, whereas Enterococcus wasdetectedin7outof18(39%)ingroupb. Conclusion : In children with upper UTI, absence of pyuria is not rare finding, particularly in children with UTI caused by Enterococcus spp. The presence of significant bacteriuria, therefore, should be sought in suspected cases. Key words : urinary tract infection, pyuria, bacteriuria, vesicoureteral reflux, E. coli, Enterococcus

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