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Q. My 11 months old child has frequent infections after pyelopasty. How to treat him?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 03, 2021

Hi doctor,

My 11 months old child gets frequent infections after pyeloplasty. Please see the attachment and suggest us.

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Hi,

Welcome to icliniq.com.

I have gone through the query. It is not uncommon to have infections after surgery and a urinary stent is placed inside. I would like to know whether it is removed or it is still inside. From your description, it appears that the stent is not removed. If the stent is still inside, it is good to remove the stent. You can give a course of antibiotics for at least three weeks and it clears the infection in the children.

Thank you doctor,

Yes sir, the stent is still inside. Please tell me a proper time to remove the stent for the 11 months old child. Is there any test to be done before doing the removal of the stent?

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Hi,

Welcome back to icliniq.com.

There is no specific time for removing the stent in your child. As your child has fever repeatedly, it is good to remove it. But generally, it is safe to remove it by six weeks after surgery. A urine culture has to be done before the removal of the stent and culture of the stent should be done after removal.

Thank you doctor,

At present, Pseudomonas aeruginosa is present in the urine culture. Now, it has become more resistant. Kindly see the report. The pediatric doctor has prescribed an antibiotic Meropenem injection IV. Do oral antibiotics help in this condition?

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Hi,

Welcome back to icliniq.com.

No, it cannot be treated with oral antibiotics and even injections will not help much as the stent is inside.

Thank you doctor,

Is there any problem with the stent which is giving infections again and again? Please see the attached ultrasound reports.

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Hi,

Welcome back to icliniq.com.

Yes, the stent is infected and it is necessary to remove it. I have seen the reports.

Thank you doctor,

I am going to visit a urologist after two days. At present, I am taking urine tests every day. Please mention whether a urine test is enough or a blood test is needed for treating the infection. I have attached the report.

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Hi,

Welcome back to icliniq.com.

It is not necessary to do urine tests every day. A blood test is needed when a child has a fever.

Thank you doctor,

My child has developed a high fever of 104 degrees for two times. At present, my child has no fever but I am frightened. I searched about pseudomonas aeruginosa and it occurs due to non sterilized surgical instruments. So I doubt whether the surgery was done properly or not. Please suggest whether I need to change the urologist or not.

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Hi,

Welcome back to icliniq.com.

I appreciate that you are concerned about the well being of your child. It is a good sign that he is not having a fever now. There is a clear culture and sensitivity test and it is possible to treat him with specific antibiotics that will definitely control the infection, once the stent is removed. It is true that pseudomonas infections are usually contracted in the hospital and it can be occurred due to urinary catheter-related infection after the surgery. Non-sterilized instruments in open surgery cause infection of the suture site and it does not cause urinary tract infection. I cannot comment on how the surgery was done or not without knowing the actual details about the procedure and the place where it was done. It is entirely up to you to decide whether if you want to change the doctor or not. I am sorry and I cannot make any suggestions to influence your decisions.

Thank you doctor,

Do you mean that the present infection is due to urinary catheter-related infections after surgery? The child was on antibiotic injections for a few days after surgery. Please guide us to know what is wrong.

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Hi,

Welcome back to icliniq.com.

There are so many factors that are responsible for causing infection in the post-operative period. These sorts of infections occur mostly due to catheter-related and it is the risk present in these procedures, and they persist even after giving IV (intravenous) antibiotics. I can suggest to you what can be done to manage the problem of your child.

Thank you doctor,

I am very much worried about the continuous antibiotic injections given to my child. What are the side effects and what is the cause of having high pus cells in urine?

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Hi,

Welcome back to icliniq.com.

I understand your concern. Treatment without giving medication will cause more dangerous effects. These antibiotics are given to many children and they are generally safe. They do not cause any permanent side effects. The pus cells in the urine occur due to infection and they also appear in urine when there is any stent in the kidney even without an infection.

Thank you doctor,

This is the surgery procedure done and I have attached it.

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Hi,

Welcome back to icliniq.com.

The attachment is not available.

Thank you doctor,

I have sent it again.

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Hi,

Welcome back to icliniq.com.

It is a standard operation and it is recommended for this type of condition. It is performed by urologists.

Thank you doctor,

These are the latest ultrasound, urine routine, and culture reports done after the removal of the DJ stent. The stent was removed before twenty days. The stent was infected badly by pseudomonas aeruginosa. It was more than 10^5 CFU/ml. Please tell me what to do? Why the left kidney shows hydronephrosis? What is the reason for having E.coli?

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Hi,

Welcome back to icliniq.com.

There will be some residual hydronephrosis after the surgery and it is normal. I would like to know whether your son has any symptoms of urinary tract infection till now. E.coli is a common cause of infection, and it is acquired outside the hospital. Any residual infection if present needs to be treated by taking antibiotics.

Thank you doctor,

He does not have a fever and urinates frequently. Please suggest about the other symptoms. When this hydronephrosis will go?

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Hi,

Welcome back to icliniq.com.

The other symptoms are fever and crying during passing urine. Children usually pass urine twice as frequently as adults and an increase in frequency is not definitive. Hydronephrosis resolves as the kidney grows in size with age. It takes some years and may even persist in a few children. It is more important to make sure that there is no obstruction and it is tested six to twelve months after surgery.

Thank you doctor,

Does the recent ultrasound report indicate an obstruction? What should be done to avoid such circumstances?

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Hi,

Welcome back to icliniq.com.

It does not indicate an obstruction at present. There is nothing to prevent it, but we can have a follow up to make sure it. The chance of recurrence is very less.

Thank you doctor,

Any allopathic or ayurvedic medicine will help to cure hydronephrosis? What type of follow up is required? Do we need to do an ultrasound or urine routine or culture?

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Hi,

Welcome back to icliniq.com.

Taking medications will not help to cure hydronephrosis. You need to do an ultrasound scan once every six months or a year.

Thank you doctor,

His urine routine report shows a small number of pus cells but E. Coli is still about 10^4. I am giving Walamycin DS to the child for ten days. But even after 10 days, E.coli colony count remains the same (10^4) but pus cells have decreased from twenty to four. Why only the pus cells are decreased but not the E. Coli? Do I need to change the antibiotic? This is the latest blood report of my child after the removal of the stent. He has a creatinine of 0.41 mg/dL. Does this show a good kidney function? Does a renogram test is necessary to check kidney functions?

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Hi,

Welcome back to icliniq.com.

It is necessary to change the antibiotic if the culture is persistently positive even after two weeks of treatment. The renal function appears to be normal and it is not necessary to do a renogram frequently.

Thank you doctor,

From the latest ultrasound, it seems that the right kidney has become better. Am I correct? I have attached the previous ultrasound reports before the removal of the stent.

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Hi,

Welcome back to icliniq.com.

Yes, there is an improvement and it will become better as the child grows.

Thank you doctor,

Thank you

#

Hi,

Welcome back to icliniq.com.

You are welcome.


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