urinary tract infection
Urinary tract infection; urinary tract infection from the kidneys to the last exit point of urine (urethral access) is called urinary tract infection (urinary tract infection). After childhood respiratory infections, urinary tract infection occurs in second place. The incidence of urinary tract infection is much higher in infants and newborn period and 0-3 years of age. The incidence of urinary tract infections between 0-1 years of age is 3-8%.
In the first years of life, the frequency of urinary tract infections in males is higher than in females. After the first year, the incidence of urinary tract infections in girls is higher than in men. The incidence of urinary tract infection is between 3-7% in girls aged 1-5 and this rate is 1-2% in boys. urinary tract infection in girls more common cause first;
urinary tract infection
The distance from the exit hole of the urine to the urinary bladder where urine is collected is shorter than that of men. The second reason is; The urethra with urine outlet mouth is close to each other. Any problem that may cause urinary flow to slow down in the urinary tract is a risk for the development of urinary tract infection. Stone, blockages in the canal, voiding disorders, urine; urinary bladder urinary tract retardation (vesicoureteral reflux), urinary flow slow down and pause is one of the most important causes of urinary tract infection.
In children with residual urine (residual urine) who are postponing their urine for a long time or not ending the urination, the microbes are more easily located and multiply in the urethra. Voiding disorders, typically between the ages of 3 to 7 years, are common causes of urinary tract infection.
while the frequency of recurrence in urinary tract infection is 12-30% within one year after the first infection, this rate rises to 40-50% in the first five years. Therefore, pediatric urinary tract infection should be closely monitored for the risk of recurrence. Urinary tract infections that are identified in a timely manner and are not treated, examined and followed up in children; growth-growth retardation, hypertension and progressive kidney damage may result in chronic renal failure tables.
The most important reason for the need for dialysis in the elderly and the need for kidney transplantation are urinary tract infections that are not detected and treated in a timely manner and therefore are not followed well. It is very important. The most common cause of urinary tract infection in children is intestinal bacteria. The most important of these are Ecoli (60-90%), followed by Klepsiella, Enterococci, Proteus and Pseudamanas. After the newborn period, urinary tract infection is transmitted from the bottom upwards. In girls, the microbes that cling to the mouth of the penis in men, where they multiply, lead to urinary tract, urinary bladder and even kidneys and cause urinary tract infection. 3% blood transmission, especially in the newborn, may also occur.
Symptoms of urinary tract infection in CHILDREN Urinary tract infection is the most common cause of fever in the 0-3 age group.
CHILDHOOD NEVER EXPLAINED IN THE CHILDHOOD AT ALL KINDS OF THERAPY
urinary tract infection should be considered and the child should be evaluated by making appropriate investigations. Fever, vomiting, restlessness, excessive reaction to stimulation, weakness, sleepiness, not gaining weight, growth retardation, malnutrition, diarrhea, vomiting, sometimes constipation, bad smell of urine, bleeding in urine, crying while urinating, urination in a boy, intermittent urination, decrease in reflexes and activity in the newborn period, prolonged jaundice, urinary tract infection should the baby be unable to gain weight.
Urinary tract infection should also be considered in a child with no urination problems, such as compression, daytime or nighttime wetting. Different clinical symptoms may be observed in the urinary tract infection. The urinary tract from the kidney to the urinary bladder, the bladder and the urethra from the urethra to the final exit hole of the urethra is called the pee lower urinary tract infection . Peeing, tingling, burning, frequent urination, urinary incontinence, urgent urination, smelly urine, foggy urination during lower urinary tract infection in children over 2 years old should make us think about urinary tract infection.
Upper urinary tract infection; kidney involvement. Fever, vomiting, abdominal pain, side pain, pain in the waist, weight loss, growth retardation should help us think heat Upper urinary tract infection. Children between 2 months and 2 years of age can have urinary tract infection without any symptoms. DIAGNOSIS in urinary tract infection The diagnosis is made by urine analysis with clinical findings. In order to make a definitive diagnosis, urine culture must be performed as well as urine microscopy. In full urine analysis, more than 10 leukocytes and microbes appear in each field under microscope, suggesting urinary tract infection, but urine culture is essential for definitive diagnosis.
Urine culture; infection of microbes that cause infection in a special medium. It is determined by a test called antibiotic antibiogram which will be effective in the urine microbe. In this test, antibiotics are compared in the urine culture and the most effective antibiotic is determined in the microbe. Usually plastic bags are used for urine culture. However, in suspected cases, urine culture should be performed by taking urine from the bladder (suprapubic aspiration) with a probe or in the lower part of the abdomen. Urine for culture in children aged 0-2 years; taken with plastic urine bag.
Urine bag and urine;
- Urine culture must be taken in the laboratory to be cultured. Urine culture should not be taken from outside urine and taken to the laboratory
- A person with urine culture should wash his hands with soap and water and leave to dry naturally.
- When the baby is lying on his back, the genital area, anal region, skin folds should be washed with soapy water and allowed to air dry naturally.
- In girls, skin folds are stretched, making the urine outlet and vagina visible. When inserting a bladder; before the narrow part of the bladder is adhered to the region between the vagina and the breech. Then the other parts of the bag are placed backward to the front of the urethra
- In boys, the bladder is placed from the front to the back so that the child’s penis is inside the bladder.
- The baby should be held in an upright position after the bag is inserted
- If urine cannot be taken in 30 minutes, the bladder should be replaced.
Urine control for children over 2 years of age; medium flow is done by taking urine.
Central flow urine removal:
- The reliability is very high when applied correctly.
- When lying on the baby’s back, the genital area, anal region, skin folds should be washed with soapy water and allowed to air dry naturally.
- Take care that the urine to be taken does not touch the skin or anywhere in the genital area
- Vagina leaves are stretched and stretched in girls; pulling back the foreskin in the boy; When the child starts to pee and pee uninterruptedly, the first urine is drained out, then the urine is taken directly into the sterile collection container in the middle of the urination. The collection container is retracted before the void is finished. If there is no possibility to make urine culture, besides the clinical findings, when urine dipstick is examined, leukocyte + nitrite and urine microscopy can be diagnosed and urinary tract infection can be diagnosed.
TREATMENT OF URINARY TRACT INFECTIONS
The purpose of treatment; To eliminate the infection in the urinary tract, to determine the anatomical or functional disorders that may cause urinary tract infection, to prevent recurrence of urinary tract infection and to protect the kidney function. Treatment; According to the results of urine culture, patients with the appropriate antibiotic treatment will recover quickly and fully. Selection and application of antibiotics; The age group of the patient may vary depending on the antibiotic resistance of the patient and the clinical findings of the patient.
It may take a few days for the urine culture result to be finalized. Therefore, in patients with risk of urinary tract infection; especially in children under 5 years of age, if there is a history of anatomical disorder and recurrent urinary tract infection, treatment should be started immediately without waiting for the finalization of the culture. Delayed treatment increases the risk of developing kidney damage in the treatment of urinary tract infection; appropriate antibiotic therapy should be given for 5 to 7 days in the lower urinary tract infection. In the treatment of upper urinary tract infection, appropriate antibiotic treatment should be given for 10-14 days.
Patients who receive treatment usually develop within 48-72 hours. If there is no improvement in clinical findings and urine microscopy after 72 hours, treatment should be changed considering that there may be an infection caused by resistant microbes caused by urinary tract infection or urinary tract obstruction. Microscopic examination of the urine 2-3 days after the completion of the treatment, urine culture 7-10 days after the complete pass through urinary tract infection should be checked.
Recurrent urinary tract infection may require a 6-month-1-year preventive antibiotic treatment depending on the clinical condition of the child, the frequency of recurrences, the condition of leakage and the state of anatomical abnormalities.
PROTECTION OF URINARY TRACT INFECTIONS
- Children should be provided with plenty of fluid
- Warnings should be made to urinate frequently. Children should be able to urinate 6-8 times a day with 4-5 hour intervals
- The child pee; the urinary bladder should be emptied completely. No urine in the bladder
- Very good cleaning of anal and genital area should be done
- Sub-cleaning of girls should be done from front to back. Wiping cloth should be used in vaginal area only once, if it is necessary to wipe again, a new cloth should be wiped from front to back
- Children should not be dressed in nylon and tight clothing
- No foam bath in still water
- Do not use perfume and deodorant on the genital area
- If intestinal parasites are treated
- Take care not to remain constipated. Consume plenty of water and juicy foods, protein, carbohydrate and fat ratio balanced, vegetables and fruits should be provided with a diet
- Comply with hygiene rules. Especially in newborn babies should be replaced with frequent diapers, prolonged contact of urinary tract with faeces should be prevented
- Newborn circumcision should be prevented, contrary to known circumcision penis covering the penis head protects against external negativity and urinary tract infection
- Can increase the frequency of diarrhea and urinary tract infection. Necessary precautions should be taken for this