Incidence of urinary tract infection after cystography / Incidência de infecção urinária após cistografia

ABSTRACT Objective: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

RESUMO Objetivo: A cistografia é um exame invasivo que apresenta potencial iatrogenia, nomeadamente infecção urinária (IU). Os estudos sobre a incidência de complicações associadas a esse exame são escassos. O objetivo deste trabalho foi avaliar a incidência de IU após realização de cistografia. Métodos: Estudo retrospetivo por consulta dos prontuários clínicos dos doentes com idade inferior a 15 anos, seguidos em consulta nesse hospital, que realizaram cistografia (radiológica ou isotópica) entre 2009 e 2018. Admitiu-se relação de causalidade quando o diagnóstico de IU ocorreu até sete dias após a realização do exame. Foi realizada análise estatística descritiva e utilizados testes não paramétricos para avaliar possíveis fatores preditores da ocorrência de IU após cistografia. Resultados: Realizaram-se 531 cistografias (55% isotópicas e 45% radiológicas). A mediana de idade foi de 11,5 meses; 62% eram do sexo masculino. Todos os doentes efetuaram urocultura prévia (negativa); 50% recebiam profilaxia antibiótica (ATB) à data do exame. A indicação mais frequente foi o estudo pós-natal de hidronefrose (HN) congênita/outra malformação nefrourológica (53%), seguida do estudo da IU febril (31%). Documentou-se refluxo vesicoureteral (RVU) em 40% dos exames. Ocorreu IU após cistografia em 23 casos (incidência de 4,3%). O microrganismo mais frequente foi a E. coli (52%). Verificou-se associação entre a presença de RVU e a ocorrência de IU. Conclusões: A incidência de IU pós-cistografia foi relativamente baixa na amostra deste estudo. Observou-se associação entre a ocorrência de IU após cistografia e a presença de RVU. Sublinha-se a importância de uma técnica adequada de cateterização vesical e da vigilância clínica após o exame.

INCIDENCE OF URINARY TRACT INFECTION AFTER CYSTOGRAPHY.

OBJECTIVE: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). METHODS: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. RESULTS: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. CONCLUSIONS: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

[Acute gastroenteritis by Cambylobacter spp: a retrospective study of a paediatric emergency department]. / Gastroenterite Aguda por Campylobacter Spp: Casuística de uma Urgência Pediátrica.

INTRODUCTION: Infection by Cambylobacter occurs worldwide and represents the main cause of acute bacterial gastroenteritis within the European Union. AIMS: Determine the prevalence of Campylobacter in stool cultures from patients with gastroenteritis and study their microbiological, epidemiological, clinical, and therapeutic profiles, as well as associated complications. MATERIAL AND METHODS: Review of clinical files of patients presenting to the paediatric emergency department of a general district hospital over a 30 month period with an acute gastroenteritis and a Campylobacter isolated in a stool specimen. RESULTS: Out of 216 stool cultures, 98 (45%) were positive. We identified Campylobacter in 49 (50%) cases; 30 (61%) were female. Median age was 23 months. Fourteen patients were under one year of age, 25 between one and five years old and 10 patients were over five years old. Watery diarrhea was identified in 5 (10%) patients, bloody diarrhea in 44 (90%) and mucosanguineous in 14 (29%), while 23 (47%) had fever, 14 (29%) complained of abdominal pain and 11 (22%) presented with vomiting. One patient was septic. Five patients were admitted as inpatients. Eight patients were treated with azithromycin. DISCUSSION: This is the largest published national series on gastroenteritis by Campylobacter in children and the first in the south region. Campylobacter was the main bacteria isolated. Infection was self-resolving in the majority of cases. Nevertheless, severe forms of this infection should be considered. Increased resistance to quinolones is worrisome. CONCLUSION: Judicious use of stool cultures allows etiological identification of bacterial gastroenteritis. The increase in Campylobacter cases reinforces the need for better control of hygiene measures in handling food products.

Introdução: A infeção por Campylobacter é a principal causa de gastroenterite aguda bacteriana pediátrica na União Europeia.Objetivos: Conhecer a prevalência de isolamento deste agente nas crianças admitidas na urgência com gastroenterite aguda que realizaram coprocultura, caracterizando a microbiologia, epidemiologia, clínica, terapêutica e complicações associadas.Material e Métodos: Casuística por consulta dos processos dos doentes admitidos na Urgência Pediátrica dum hospital distrital, durante 30 meses, com o diagnóstico de gastroenterite aguda e isolamento em coprocultura de Campylobacter.Resultados: Das 216 coproculturas efetuadas, 98 (45%) foram positivas. Identificámos Campylobacter spp. em 49 (50%) doentes. Destes, 30 (61%) eram do género feminino. A mediana de idades foi 23 meses. Catorze doentes tinham idade inferior a um ano, 25 entre um e cinco anos e 10 idade superior a cinco anos. Verificámos diarreia aquosa em cinco (10%) doentes, diarreia com sangue em 44 (90%), sangue e muco em 14 (29%), febre em 23 (47%), dor abdominal em 14 (29%) e vómitos em 11 (22%). Registámos um caso de sépsis. Internámos cinco doentes. Oito doentes foram medicados com azitromicina.Discussão: Esta é a maior casuística nacional publicada de gastroenterite aguda a Campylobacter em idade pediátrica e a primeira no sul do país. Campylobacter foi a principal bactéria identificada, associada maioritariamente a doença auto-limitada. Contudo, há a considerar formas de infeção graves. O aumento da resistência às quinolonas é preocupante.Conclusão: A utilização criteriosa da coprocultura permite a identificação etiológica na gastrenterite aguda bacteriana. O crescente aumento dos casos de Campylobacter diagnosticados reforça a necessidade de maior controlo das medidas de higiene na manipulação dos alimentos.

[Multicystic dysplastic kidney. In defense of a conservative experience]. / Displasia renal multiquística: em defesa de uma experiência conservadora.

INTRODUCTION: Multicystic dysplastic kidney (MDK) is one of the most common congenital anomalies of the urinary tract and the main cystic renal disease in children. Our institution follow-up protocol of MDK uses, as has been performed more widely in the last two decades, a conservative attitude. OBJECTIVES: To characterize MDK cases followed in our Outpatient Clinic of Pediatric Nephrology, evaluate their progress and reflect on the protocol adopted. METHODS: 36 MDK patients observed between January 1995 and December 2009 were included in this retrospective study and followed-up. In 35 children the diagnosis was the result of prenatal ultrasound. All children underwent a systematic protocol, including conservative treatment (no surgery) and periodic clinical, laboratory and ultrasound evaluation. All children underwent a MAG3 renogram or a 99mTc-DMSA renal scintigraphy and a voiding cystourethrography, only repeated in cases of vesicoureteral reflux (VUR). RESULTS: Eighteen children (50%) are male. The median age of first visit was four weeks. The median of follow-up was 65 months. The MDK was in the left kidney in 20 children (56%). The median age of onset was 10 and six weeks Contralateral nephro-urologic pathology was identified in 10 cases (28%): seven children with VUR (grade ≥ IV in three), two with ureteropelvic junction obstruction (UPJO) and one with mild pelvic dilatation. There was involution of dysplastic kidney in 27 cases (75%), partial in 24 and total in three. The involution rate was higher in the first 36 months. There was a progressive compensatory hypertrophy of the contralateral kidney, with the highest rate in the first two years of life. There was resolution of VUR in five of the seven units reflux (three spontaneous and two after ureteral reimplantation). The two children with UPJO underwent surgery. There was no malignant degeneration and there was not carry out any nephrectomy of dysplastic kidney. Urinary infection occurred in nine children (25%), three of which have VUR and two with UPJO. There were no cases of hypertension or decreased glomerular filtration rate. CONCLUSIONS: The results of this study are generally consistent with other casuistics and confirm the fairness of a conservative attitude in the approach of children with MDK. This clinical approach is safe, with a minimum incidence of complications, with tendency to involution of dysplasic kidney being the rule.

Acute pancreatitis associated with varicella infection in an immunocompetent child.

Acute pancreatitis associated with varicella-zoster infection is a rare event, particularly in immunocompetent children. We report on a case of acute pancreatitis in a 6-year old girl presenting with acute abdominal pain less than 72 hours after the onset of a typical vesicular rash. The diagnosis was confirmed through hyperamylasaemia, ultrasonographic findings of oedematous pancreatitis and acute seroconversion to varicella-zoster virus, after excluding more common causes of acute pancreatitis. Conservative treatment was initiated, with complete resolution of symptoms and absence of local or systemic complications on follow up. A review of the literature revealed only three previously reported cases, with very different outcomes, highlighting the need to consider this potentially fatal complication in every child presenting with acute abdominal pain during the course of varicella disease.