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Neues zu Harnwegsinfektionen bei Kindern

New aspects of urinary tract infections in children

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Zusammenfassung

Verbesserte diagnostische Verfahren und die Verfügbarkeit neuer Medikamente haben zu einer Optimierung der Behandlung von Harnwegsinfektionen (HWI) geführt. Aktuell diskutierte Fragen betreffen u. a. Therapiestrategien bei Pyelonephritis im Säuglings- und Kleinkindalter, den Umgang mit der Resistenzentwicklung uropathogener Bakterien, konkurrierende Konzepte der bildgebenden Diagnostik und die Effizienz der antibakteriellen Rezidivprophylaxe. Die kalkulierte antibakterielle Therapie muss sich zunehmend an der jeweils regionalen Resistenzsituation uropathogener Bakterien orientieren. Jenseits des frühen Säuglingsalters ist die orale Applikation geeigneter Antibiotika bei unkomplizierten Pyelonephritiden angemessen. In aktuellen Leitlinien gehört die Sonographie im Säuglings- und Kleinkindalter zur Basisdiagnostik bei fieberhaften HWI. Die Refluxdiagnostik bleibt dagegen denjenigen Kindern vorbehalten, bei denen angesichts klinischer Kriterien oder dem Vorliegen wegweisender sonographischer Auffälligkeiten ein behandungsbedürftiger vesikorenaler Reflux wahrscheinlich ist. Aktuelle Studien belegen die Effizienz einer antibakteriellen Rezidivprophylaxe bei gefährdeten Patienten. Bei Mädchen mit rezidivierenden Zystitiden gewinnen die pathogenetische Rolle von Blasen- und Darmfunktionsstörungen und der Einsatz der Urotherapie praktische Relevanz.

Abstract

Improved diagnostic procedures as well as the availability of novel drugs have led to an optimization in the treatment of urinary tract infections in infancy and childhood. Current important issues under discussion are the therapeutic strategies for pyelonephritis in infancy and early childhood, how to deal with resistance development of uropathogenic bacteria, competing concepts of diagnostic imaging and the efficiency of antibacterial prophylaxis for recurrence. Increasingly, calculated antibacterial therapy must be oriented to the respective regional resistance situation of uropathogenic bacteria. Beyond early infancy, oral administration of suitable antibiotics is appropriate in uncomplicated cases of pyelonephritis. According to the current guidelines, sonography in infancy and early childhood is part of the basic diagnostic regimen for febrile urinary tract infections. Reflux diagnostics, however, remain reserved for children in whom a vesicorenal reflux is likely in view of clinical criteria or the existence of conclusive sonographic abnormalities. Recent studies have proven the efficiency of prophylaxis for antibacterial recurrence in patients at risk. In girls presenting with recurrent cystitis, the pathogenic role of functional bladder or bowel disorders as well as the use of urotherapy are gaining practical relevance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Beetz und E. Kuwertz-Bröking geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

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

    R. Beetz

  2. Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Deutschland

    E. Kuwertz-Bröking

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Correspondence to R. Beetz.

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Beetz, R., Kuwertz-Bröking, E. Neues zu Harnwegsinfektionen bei Kindern. Monatsschr Kinderheilkd 163, 323–330 (2015). https://doi.org/10.1007/s00112-014-3225-3

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  • DOI: https://doi.org/10.1007/s00112-014-3225-3

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