Urosepsis bei Kindern und Jugendlichen – konservative und operative Therapie

Zusammenfassung

Fieberhafte Harnwegsinfekte (HWI) sind die häufigsten Infektionen im Kindesalter, die Urosepsis, wenngleich selten, stellt die schwerste Komplikation der kindlichen Infektion des Urogenitaltraktes dar. Die korrekte Diagnose, insbesondere die Mitbeteiligung der Nieren im Säuglings- und Kleinkindesalter kann aufgrund der unspezifischen Symptome schwierig sein, neben Harn und Labor sowie nicht invasiver Diagnostik (Ultraschall) kann eine weitere spezifische Diagnostik (DMSA Szintigrafie) notwendig sein. Die Akuttherapie besteht aus der gezielten parenteralen Antibiose wie der qualifizierten pädiatrischen Sepsistherapie, selten ist eine chirurgisch-interventionelle Desobstruktion nötig. Hier kommen neben der Katheterdrainage des unteren und oberen Harntraktes offene Operationstechniken – situations- und kindgerecht – zum Einsatz. Im weiteren Verlauf ist es entscheidend, kausale Faktoren wie angeborene Fehlbildungen mit negativem Einfluss auf den Harntransport (vesikoureteraler Reflux, Fehlbildungen mit postrenaler Obstruktion) zu identifizieren und zu behandeln.

Abstract

Urinary tract infections (UTI) are the most common infectious diseases in children. Urosepsis in childhood, though rare, is the most complicated possible variant. In newborns and infants, unspecific symptoms are a significant barrier to a fast and reliable diagnosis, which is crucial to successful treatment. In addition to urine and laboratory tests as well as non-invasive examinations (ultrasound), there may be an indication for invasive examinations of the kidneys (DMSA scans) in cases of a severe infection. Conservative therapy consists of targeted parenteral antibiotic treatment and paediatric sepsis management. Surgical desobstruction and urinary diversion are indicated if conservative therapy has failed. In addition to catheterised drainage of the upper and lower urinary tract, open surgery techniques are used in due consideration of the child and situation. Also, causal factors such as congenital malformations of the urinary system leading to impaired urinary drainage (vesicoureteral reflux, obstruction) have to be evaluated and treated.

Schlüsselwörter

Urosepsis - fieberhafte Harnwegsinfekte - Kindesalter - spezifische Diagnostik - konservative, chirurgische Therapie - kongenitale Fehlbildungen des Urogenitaltrakts

Keywords

Urinary tract infections - childhood - SIRS - diagnosis - conservative therapy - surgical therapy - congenital urogenital malformations

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