URINARY TRACT INFECTION: DIAGNOSIS AND MANAGEMENT OF THE INITIAL UTI IN INFANTS 0 TO 12 MONTHS Author: Oana Andrea Edina Coordinator: Dr. Duicu Carmen,PhD, Lecturer Co-author: Ortopan Maria, Nagy Iulia Andrea

Introduction The urinary tract infection (UTI) is caused by the emergence of certain bacterium in the bladder and sometimes in the kidneys, most commonly involved bacterium is E.Coli. After upper respiratory tract infections, UTI occupy second place as common in children. Definitive diagnosis of UTI requires isolation of a uropatogen agent in the urine culture. Significant bacteriuria is given by the presence of 10 5 colonies of germs/ml. In newborns and infants the most recommended methods to take urine sample are the urinary catheterisation and suprapubic aspiration (is considered the "gold standard“ ). UTI most often is associated with certain, renal malformations, including hydronephrosis, renal duplicity, vezicoureteral reflux(VUR).

Diagnosis of UTI in infants Positive urine culture Fever Jaundice Digestive or nervous phenomena Dehydration syndrome Indisposition Biological parameters

Objective Risk factors: age, gender, renal malformations, renal anomalies Diagnosis Urine culture prevention of recurrent UTI

Material and Method We performed a retrospective observational-analytic study on 261 infants with ages ranging between 0 and 12 months, boys and girls. All infants were diagnosed with UTI. The method used for diagnosis of UTI was the urine culture, and the determination of certain renal malformations was made possible with the help of renal ultrasound, retrograde cystography and renal scintigraphy.

Results 261 infants 150 boys 111 girls

Distribution by age and sex Sex FM Age 0-1month 1-3months > 3months P 0.03

The etiology of UTI P > 0.05

The importance of the creatinine In the group studied the value of creatinine is 0,3mg/dl. 62% had nitrate retention Of these, three infants were diagnosed with chronic kidney failure stage IV. P > 0.05

Renal malformations which could facilitate in a certain way the emergence of UTI In our study we observe d that most commonly affected age group is over 3 months. P > 0.05

The Retrograde Cystography in the first episode of UTI for exclusion of RVU. Appreciating the infants age we tried to see what age group is most susceptible to more frequent RVU. The results have shown us that the most prone to RVU is the age group over 3 months P 0.003

Conclusions UTI occupy an important role in renal pathology in infants, affecting boys and girls and it is one of the most common infections found in children. In the first month of life the UTI frequency is higher in boys compared to girls, and as age increases the frequency of infection tends to be equal between the sexes. It is necessary to identify the bacterium that has led to the emergence of UTI, and our study showed a higher frequency of E.Coli. There have been many discussions if the infection itself may lead eventually to a chronic kidney disease, but studies have shown that a simple UTI without complication does not lead to chronic kidney disease.

Nitrate retention is important to be evaluated because it's a good marker in terms of the development and occurrence of chronic kidney disease. The association of UTI with VUR appears constant and is the leading cause of renal parenchymal scarring and progression in the end to a cronic kidney disease. The risk of developing renal scar was found in infants who have experienced some degree of VUR, high fever and PCR positive. The treatment of UTI is made on the basis of a positive urine culture, to be able to properly treat the infection. Diagnosis and treatment of UTI are essential in preventing complications in the renal parenchyma.

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