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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months
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Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months

机译：尿路感染：2到24个月高热婴儿和儿童初始UTI的诊断和管理的临床实践指南

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摘要

OBJECTIVE: To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. METHODS: Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded. RESULTS: Diagnosis is made on the basis of the presence of both pyuria and at least 50 000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystoure-thrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydro-nephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances. VCUG should also be performed if there is a recurrence of a febrile UTI. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care; variations may be appropriate. Recommendations about antimicrobial prophylaxis and implications for performance of VCUG are based on currently available evidence. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Random...
机译：目的：修订美国儿科学会关于诊断和处理高热婴幼儿初始尿路感染（UTI）的实践参数。方法：对自最新版指南以来发表的医学文献进行分析，并补充了近期出版物作者提供的数据分析。支持和推荐每项建议的证据强度和强度。结果：在适当收集的尿液样本中，每毫升一种泌尿致病菌中均存在脓尿和至少50 000个菌落，因此进行了诊断。抗菌治疗7至14天后，应保持密切的临床随访监测，以便迅速诊断和治疗复发性感染。应当对肾脏和膀胱进行超声检查以发现解剖异常。最近的6项研究的数据不支持使用抗菌素预防措施预防无膀胱输尿管反流（VUR）或I至IV VUR级婴儿的发热性UTI复发。因此，不建议在首次UTI后常规行排尿性膀胱尿囊造影（VCUG）。如果肾脏和膀胱超声检查显示肾盂积水，瘢痕形成或其他发现提示高级别VUR或阻塞性尿毒症以及其他非典型或复杂临床情况，则表示VCUG。如果再次出现高热的UTI，也应执行VCUG。本指南中的建议并不表示专门的治疗方案或作为护理的标准;变化可能是适当的。关于抗菌药物预防及其对VCUG性能的影响的建议均基于现有证据。如同所有美国儿科学会的临床指南一样，建议将定期进行审查，并纳入新的证据，例如来自Random的数据。

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