Pustules With Fever And Uti Symptoms
  Pustules with fever and UTI symptoms is defined as the presence and proliferation of microorganisms in the gastrointestinal tract urinary; evident bacterial infection is more common in children. Approximately 1-2% of children and 3-5% of girls suffer at least 1 episode. The prevalence of UTIs in febrile children varies according to age (higher in children under 1 years) and sex (higher in girls than in children under 1 year), and can reach 8-10% of cases.
Although in most cases the prognosis is favorable, the ITU are at risk of kidney damage produce
definitive, particularly those enrolled as acute pyelonephritis (PNA). Early treatment is correlated with a decreased risk of causing renal scarring. The idea that abnormalities of the urinary tract and especially vesicoureteral reflux (VUR) may increase the risk of suffering complications from UTI they are based on little evidence, and probably only relevant in cases of VUR IV / V. Recurrences are frequent after a first ITU, 50% of girls also presented in the first year, and 75% in the following 2 years in the case of men there is no definitive data, but relapses are common in less than 1 year and infrequent in older age. Should only be considered as the diagnosis of UTIs in the presence of symptoms
The diagnosis is established by the urine culture. It is possible to establish a presumptive diagnosis in the presence of symptoms and abnormal urine depending on age and quality of the urine sample collection. In infants under 3 months of age with fever without focus (FSF) of short evolution and normal urine sediment should not be ruled out this diagnosis initially, but collecting urine culture and repeat the analytical assessment of the urine 24 hours later. The difficulty in collecting urine samples constitute valid clinical challenges specific to this condition, preferably the probing suprapubic bladder puncture in children
incontinent.
A child with presumptive diagnosis of ITU needs to be treated empirically with an antimicrobial
After the samples collected for culture by a suitable technique. The choice of treatment Initial empiric antibiotic should be tailored to local prevalence patterns of agents and their sensitivity to antimicrobials. E. coli is the most common etiologic agent in children without uropathy before. In our means, E. coli presents a high resistance to ampicillin, cotrimoxazole and cephalosporin 1st generation, while maintaining a high sensitivity to cephalosporins of second and third generation fosfomycin, aminoglycosides and amoxicillin / clavulanate.
It is notorious the marked variability in the practical management of childhood UTI in our environment, especially in regards the use of imaging tests, probably reflecting the limited evidence available. Must highlight the work of the group coordinated by C. Ochoa (2007) and the momentum that will lead to practical based on objective evidence. |
