儿科学与治疗
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国际标准期刊号: 2161-0665
国际标准期刊号: 2161-0665
Ehsan N*、Haia N、Doua B、Michael H、Boshra N、Hino B、Wael N
背景：尿路感染（UTI）是儿童期常见且可能严重的细菌感染。尿路感染是高烧儿童尤其是婴儿期儿童住院的最常见原因，也是该年龄段菌血症的常见来源。在婴儿期，该病多见于男孩，女孩发病率随着年龄的增长而增加，研究发现未割包皮的儿童尿路感染的发病率较高。首次感染肾盂肾炎（肾组织炎症）的儿童中，30% 在出生后第一年感染时会出现复发性尿路感染。引起这些感染的最常见细菌是大肠杆菌（E-coli），后来是革兰氏阴性菌（-），例如肺炎克雷伯菌和奇异变形杆菌，和革兰氏阳性 (+) 细菌，如肠球菌。已发现 ESBL + 耐药细菌在复发性尿路感染中更具有泌尿道致病性。我们本研究的目的是描述五岁以下幼儿尿路感染的流行病学和微生物学特性以及影像学。在我们的研究中，我们检查了反流的意义、其程度，以及对于任何上尿路感染是否需要进行膀胱造影检查。此外，研究不同的炎症指标（白细胞、C 反应蛋白测试）、肾脏超声检查结果和 DMSA 肾脏图谱也很重要。我们本研究的目的是描述五岁以下幼儿尿路感染的流行病学和微生物学特性以及影像学。在我们的研究中，我们检查了反流的意义、其程度，以及对于任何上尿路感染是否需要进行膀胱造影检查。此外，研究不同的炎症指标（白细胞、C 反应蛋白测试）、肾脏超声检查结果和 DMSA 肾脏图谱也很重要。我们本研究的目的是描述五岁以下幼儿尿路感染的流行病学和微生物学特性以及影像学。在我们的研究中，我们检查了反流的意义、其程度，以及对于任何上尿路感染是否需要进行膀胱造影检查。此外，研究不同的炎症指标（白细胞、C 反应蛋白测试）、肾脏超声检查结果和 DMSA 肾脏图谱也很重要。
Research methods: The study is retrospective that included infants and children up to the age of five who were hospitalized at Ziv Medical Center Safed in northern Israel in the pediatric department between 2010-2019, with the diagnosis of the first episode of urinary tract infection or recurrent episodes in the first five years of life. All children had symptoms and signs of urinary tract infection. The children underwent laboratory tests including cell blood count (CBC), kidney and electrolyte functions, C-reactive protein (CRP), blood culture, and urine sample. Following imaging of renal and urinary tract ultrasound, cystography was done after 4-6 weeks according to the protocol. Children underwent renal mapping with DMSA after 4 to 5 months of acute urinary tract infection.
Results: The data showed a greater tendency for girls aged one year and older to have UTI. The average hospitalization time was 48 to 72 hours. We found no association with maternal smoking. Breastfed babies have lower rates of urinary tract infections in the first year. The most common uropathogens are E-coli, Klebsiella pneumonia, Proteus mirabilis, and Enterococci. Antibiotic resistance was observed in recurrent infections by E-Coli 20%, ESBL to 30%, And Klebsiella 45%. 30% to 40% developed recurrent urinary tract infections, recurrent infections were within two to four months after the first infection. In most children, empiric antibiotic therapy of Ampcilin and aminoglycoside was started. Most children underwent renal ultrasound, 35% had pathological imaging of hydronephrosis, and some with hydroureter. 40% of the children who underwent cystography had reflux with varying degrees, 60% of those who did mapping (DMSA) were pathological mapping (filling defect, scar). 18% of children with normal DMSA results had reflux. CRP, rates were found to be high in all children with pyelonephritis and reflux.
结论：尿路感染的经验性治疗对于预防肾疤痕的发展非常重要。复发性尿路感染的特征是各种尿路致病菌和抗生素耐药性倾向。因此，有必要选择合适的抗生素。作为可用的肾脏超声成像检查，无需辐射，可以在医院进行。大多数上尿路感染病例不需要膀胱造影。DMSA 肾脏图谱可以揭示肾脏损伤的附加价值。包括红细胞沉降率 (ESR) 和 CRP 在内的炎症指标表明存在肾组织受累，例如肾盂肾炎。关键词： 尿路感染；皮隆