Early antibiotic therapy and risk of renal scarring in children with a first uncomplicated urinary tract infection

Česká verzia

Authors: V. Jankó; L. Kovács
Authors place of work: Bratislava ; Detská klinika Lekárskej fakulty Univerzity Komenského a Detskej fakultnej nemocnice s poliklinikou
Published in the journal: Čes-slov Pediat 2017; 72 (1): 15-19.
Category: Original Papers

Summary

Urinary tract infections are the second most common bacterial diseases in infants and children. Acute infectious tubulointerstitial nephritis (AITIN) arises as an ascending infection from the lower urinary tract and is associated with an increased risk of permanent kidney damage.

The aim of the study was to investigate the effects of febrile period before and after the initiation of antibiotics to the extent of post-inflammatory kidney damage in children with first uncomplicated AITIN.

Methods:
The cohort was composed of 221 patients aged 1 month to 18 years with first uncomplicated AITIN. In all patients the febrile interval length before and after initiation of antibiotic therapy was experienced. Renal scintigraphy was performed in 105 children after a 6-months period from overcoming the infection. The authors used the semi-quantitative analysis of the morphology scan to quantitate the extent of post-inflammatory kidney damage.

Results:
The semi-quantitative analysis revealed parenchymal defects in 113/210 kidneys, the extent of which depended on the duration of febrile period before the initiation of antibiotics (p=0.029). In 42.1% of patients the febrile interval length was longer than 48 hours. Delayed antibiotic treatment in 21.3% of children was due to the fact that the urine was not examined during the first medical examination.

Conclusion:
Our results show the importance of early antibiotic treatment in children with AITIN. They also emphasize that in a fifth of children in spite of the rapid urine test methods for outpatient clinics the urine has not been examined during the first examination for fever.

Key words:
delayed antibiotic treatment, renal scars, febrile period

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