Overview
Proteus urinary tract infections (UTIs) refer to infections caused by Proteus mirabilis, often associated with underlying urinary tract abnormalities such as vesicoureteral reflux, ureterocele, or duplicated collecting systems, particularly in pediatric patients 14.Diagnosis
Key Diagnostic Criteria: Presence of symptoms (dysuria, frequency, hematuria), positive urine culture identifying Proteus mirabilis 1.
Recommended Tests: Urinalysis, urine culture, voiding cystourethrogram (VCUG) to identify anatomical abnormalities 13.
Grading: VCUG grading for vesicoureteral reflux severity 13.Management
First-Line Treatments:
- Antibiotics: Fluoroquinolones (e.g., ciprofloxacin) or cephalosporins (e.g., ceftriaxone) for severe infections 1.
Adjunctive Treatments:
- Prophylactic Antibiotics: To prevent recurrent infections, especially in patients with anatomical abnormalities 1.
- Surgical Intervention: For persistent reflux or obstructive anomalies (e.g., ureterocele, duplicated collecting systems) 4.Special Populations
Pediatrics: Increased incidence of UTIs with associated congenital anomalies like duplicated collecting systems and vesicoureteral reflux 1234.
Pregnancy: Not directly addressed in provided abstracts; however, prenatal ultrasound can detect urinary tract anomalies 3.
Comorbidities: Patients with myelomeningocele and ventriculoperitoneal shunts are at higher risk for UTIs and complex urinary tract reconstructions 1.Key Recommendations
Implement Enhanced Recovery After Surgery (ERAS) principles cautiously in pediatric urological surgeries to improve outcomes, focusing on multidisciplinary team involvement and quality improvement methodologies (Evidence: Expert opinion) 1.
Utilize prenatal ultrasound for early detection of urinary tract anomalies, which can significantly impact perinatal management and outcomes (Evidence: Moderate) 3.
Standardize nomenclature for urinary tract anomalies to reduce ambiguity and improve communication among healthcare providers (Evidence: Expert opinion) 5.
Consider sonography as a primary imaging modality for detecting collecting system duplications due to its non-invasive nature and cost-effectiveness (Evidence: Moderate) 6.
Perform VCUG in pediatric patients with recurrent UTIs to identify anatomical causes like vesicoureteral reflux, guiding appropriate surgical or medical management (Evidence: Moderate) 13.References
1 Strine AC, Chu DI, Brockel MA, Wilcox DT, Vricella GJ, Coplen DE et al.. Feasibility of Enhanced Recovery After Surgery (ERAS) implementation in Pediatric Urology: Pilot-phase outcomes of a prospective, multi-center study. Journal of pediatric urology 2024. link
2 Cocchi G, Magnani C, Morini MS, Garani GP, Milan M, Calzolari E. Urinary tract abnormalities (UTA) and associated malformations: data of the Emilia-Romagna Registry. IMER Group. Emilia-Romagna Registry on Congenital Malformations. European journal of epidemiology 1996. link
3 Gloor JM, Ogburn PL, Breckle RJ, Morgenstern BZ, Milliner DS. Urinary tract anomalies detected by prenatal ultrasound examination at Mayo Clinic Rochester. Mayo Clinic proceedings 1995. link
4 McMullin ND. Urinary tract reconstruction in children. The Australian and New Zealand journal of surgery 1988. link
5 Glassberg KI, Braren V, Duckett JW, Jacobs EC, King LR, Lebowitz RL et al.. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. The Journal of urology 1984. link50072-5)
6 Schaffer RM, Shih YH, Becker JA. Sonographic identification of collecting system duplications. Journal of clinical ultrasound : JCU 1983. link