The Epidemiologic Assessment of Children with Acute Pyelonephritis in a 5-Years Period, Based on American Academy of Pediatrics (AAP) 2011 Guidelinee

Acute pyelonephritis (APN) is the second common significant infection in infants and children. Long-term complications of APN, scar nephropathy and hypertension, make it a serious disease at this period of life. American Academy of Pediatrics (AAP) suggested newer approach to patients with APN from 2011. We studied the epidemiologic aspect of the patients since 2011.
This retrospective study was performed by assessing the documented history of patients with APN. Patient's demographic and clinical data were recorded. Age, sex, urine culture, sensitivity status, and imaging findings were analyzed. Long-term findings such as recurrent urinary tract infection (UTI), kidney scar, and outcome of vesicoureteral reflux were assessed.
Findings: A total of 360 children with mean age of 35.2 months, (81% female) were enrolled in study. The most common organism was Escherichia coli (78%) with at least 82% sensitivity to third generation cephalosporins, aminoglycosides, and carbapneme. The resistance of Escherichia coli to co-trimoxazole and nalidixic acid was 44% and 38%, respectively. 26 patients (7.6%) suffered from recurrent UTI; and recurrence was related patient's age. Hydronephrosis, vesicoureteral reflux, and scar were respectively reported in 20%, 46%, and 47% of children imaging were performed for them.
APN is a serious and significant infection in children yet. The most common organism is Escherichia coli. Long-term complications confirm that strict follow up and assessment of the patients is very advisable.