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Abstract：
UNASSIGNED: Urinary tract infection (UTI) in children is a major source of office visits and healthcare expenditure. Research into the diagnosis, treatment, and prophylaxis of UTI has evolved over the past 10 years. The development of new imaging techniques and UTI screening tools has improved our diagnostic accuracy tremendously. Identifying who to treat is imperative as the increase in multi-drug-resistant organisms has emphasized the need for antibiotic stewardship. This review covers the contemporary management of children with UTI and the data-driven paradigm shifts that have been implemented into clinical practice.
UNASSIGNED: With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on Escherichia coli may change the way we treat children with recurrent UTIs.
UNASSIGNED: The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. E. coli is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.
UNASSIGNED: With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on Escherichia coli may change the way we treat children with recurrent UTIs.
UNASSIGNED: The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. E. coli is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.
摘要：
■儿童尿路感染（UTI）是就诊和医疗支出的主要来源。研究诊断，治疗,在过去的10年里，UTI的预防也在不断发展。新的成像技术和UTI筛查工具的开发极大地提高了我们的诊断准确性。由于多重耐药生物的增加强调了对抗生素管理的必要性，因此必须确定谁来治疗。这篇综述涵盖了UTI儿童的当代管理以及已实施到临床实践中的数据驱动范式转变。
■最近的数据显示了临床上显着的膀胱输尿管反流（VUR）的自限性和低患病率，儿童的调查成像越来越不频繁。对比增强排尿尿路图（CEVUS）已成为一种有用的诊断工具，因为它可以在不需要辐射的情况下提供VUR的准确检测。正在研究泌尿和肠道微生物作为潜在的治疗药物靶标，由于复发性UTI患儿的细菌增殖有显著改变。在患有肾盂肾炎的儿童中使用辅助皮质类固醇可以降低肾脏瘢痕形成和进行性肾功能不全的风险。针对大肠杆菌上存在的抗原的疫苗的开发可能会改变我们治疗复发性UTI儿童的方式。
■美国儿科学会将UTI定义为存在至少50,000CFU/mL的通过膀胱导管插入术获得的单一尿路病原体，尿液显微镜上存在白细胞酯酶（LE）或WBC阳性的试纸尿液分析。尿路感染在女性中更常见，未割礼的男性在生命的第一年风险最高。大肠杆菌是UTI诊断中最常见的培养生物，并且多药耐药菌株变得越来越普遍。诊断应该用未污染的尿液样本来确认，从中流收集中获得，膀胱导管插入术,或耻骨上抽吸术。符合成像标准的患者应进行肾脏和膀胱超声检查，根据超声或临床病史的结果进行进一步的调查成像。持续的抗生素预防是有争议的;然而，有证据表明，高度VUR和膀胱和肠功能障碍的患者保留了最大的获益。开放的反流手术修复是对某些人群可用的内窥镜方法进行医疗管理失败的患者的金标准。
■最近的数据显示了临床上显着的膀胱输尿管反流（VUR）的自限性和低患病率，儿童的调查成像越来越不频繁。对比增强排尿尿路图（CEVUS）已成为一种有用的诊断工具，因为它可以在不需要辐射的情况下提供VUR的准确检测。正在研究泌尿和肠道微生物作为潜在的治疗药物靶标，由于复发性UTI患儿的细菌增殖有显著改变。在患有肾盂肾炎的儿童中使用辅助皮质类固醇可以降低肾脏瘢痕形成和进行性肾功能不全的风险。针对大肠杆菌上存在的抗原的疫苗的开发可能会改变我们治疗复发性UTI儿童的方式。
■美国儿科学会将UTI定义为存在至少50,000CFU/mL的通过膀胱导管插入术获得的单一尿路病原体，尿液显微镜上存在白细胞酯酶（LE）或WBC阳性的试纸尿液分析。尿路感染在女性中更常见，未割礼的男性在生命的第一年风险最高。大肠杆菌是UTI诊断中最常见的培养生物，并且多药耐药菌株变得越来越普遍。诊断应该用未污染的尿液样本来确认，从中流收集中获得，膀胱导管插入术,或耻骨上抽吸术。符合成像标准的患者应进行肾脏和膀胱超声检查，根据超声或临床病史的结果进行进一步的调查成像。持续的抗生素预防是有争议的;然而，有证据表明，高度VUR和膀胱和肠功能障碍的患者保留了最大的获益。开放的反流手术修复是对某些人群可用的内窥镜方法进行医疗管理失败的患者的金标准。
