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Diagnostik und Therapie von Harnwegsinfektionen

Diagnostics and therapy of urinary tract infections

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Zusammenfassung

Harnwegsinfektionen (HWI) im Säuglings- und Kleinkindesalter verlaufen oft mit unspezifischen Symptomen. Für die exakte mikrobiologische Diagnose ist die Art der Uringewinnung entscheidend. Sie sollte im Säuglingsalter durch eine suprapubische Blasenpunktion oder über einen transurethralen Einmalkatheter erfolgen. Die kalkulierte Therapie bei v. a. Pyelonephritis besteht bei jungen Säuglingen aus der Kombination eines Cephalosporins der Gruppe 3a oder eines Aminoglycosids mit Ampicillin. Ab dem Kleinkindesalter kann eine perorale Behandlung mit einem Cephalosporin der Gruppe 3 bei unkomplizierter Pyelonephritis durchgeführt werden. Zum Ausschluss von Nieren- oder Harnwegsfehlbildungen wird bei erster Pyelonephritis eine sonographische Untersuchung empfohlen. Die Strategien zur Refluxdiagnostik und zur Erkennung von Parenchymdefekten werden kontrovers diskutiert. Die aktuellen AAP-Guidelines für fieberhafte HWI im Säuglings- und Kleinkindalter werden voraussichtlich die noch ausstehenden evidenzbasierten Leitlinien hierzulande beeinflussen.

Abstract

In infants and young children, urinary tract infections (UTI) often present with unspecific symptoms. Appropriate techniques of urine sampling play an important role for accurate microbiological diagnosis. In infants urine sampling by bladder puncture or transurethral catheter is recommended. In young infants with suspected pyelonephritis, calculated antibiotic treatment should be initiated parenterally with a combination of a third generation cephalosporin or an aminoglycoside with ampicillin. After the age of 3-6 months group 3 oral cephalosporins can be used in uncomplicated pyelonephritis. With the first febrile UTI early sonography is recommended to provide information about renal parenchymal involvement and to exclude malformations of the kidneys and urinary tract. Strategies for the recognition of vesicoureteral reflux and renal damage are under discussion. Recently published guidelines by the American Academy of Pediatrics for the diagnosis and management of UTI in febrile children and infants aged 2-24 months will most likely influence the still pending German guidelines.

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Authors and Affiliations

  1. Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Johannes Gutenberg- Universität, Langenbeckstraße 1, 55101, Mainz, Deutschland

    R. Beetz

  2. Klinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen, Gießen, Deutschland

    F. Wagenlehner

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Correspondence to R. Beetz.

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Beetz, R., Wagenlehner, F. Diagnostik und Therapie von Harnwegsinfektionen. Urologe 52, 21–32 (2013). https://doi.org/10.1007/s00120-012-3078-0

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