Abstract：
BACKGROUND: The appropriate duration of antimicrobial therapy for febrile urinary tract infection (fUTI) in children has not been established. This study examined the optimal duration of treatment for fUTI in children.
METHODS: We created a protocol that used fever duration to determine the duration of antibiotic administration. Transvenous antibiotics were administered until 3 days after resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine yielded a bacteria count of ≥5 × 104. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed on the basis of contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed treatment outcomes.
RESULTS: Of the 78 patients treated according to our protocol, data from 58 were analyzed-49 children (30 boys) had PN and nine (three boys) had AFBN. Blood test results showed that patients with AFBN had significantly higher white blood cell counts and C-reactive protein levels than did those with PN; however, urinary findings and causative bacteria did not differ between groups. Time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported administration period of 3 weeks. No recurrence was observed in AFBN patients.
CONCLUSIONS: A protocol that used fever duration to determine the duration of antimicrobial treatment was useful. Invasive examinations, such as eCT, were not required.
METHODS: We created a protocol that used fever duration to determine the duration of antibiotic administration. Transvenous antibiotics were administered until 3 days after resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine yielded a bacteria count of ≥5 × 104. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed on the basis of contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed treatment outcomes.
RESULTS: Of the 78 patients treated according to our protocol, data from 58 were analyzed-49 children (30 boys) had PN and nine (three boys) had AFBN. Blood test results showed that patients with AFBN had significantly higher white blood cell counts and C-reactive protein levels than did those with PN; however, urinary findings and causative bacteria did not differ between groups. Time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported administration period of 3 weeks. No recurrence was observed in AFBN patients.
CONCLUSIONS: A protocol that used fever duration to determine the duration of antimicrobial treatment was useful. Invasive examinations, such as eCT, were not required.
摘要：
背景：儿童发热性尿路感染（fUTI）抗菌治疗的适当持续时间尚未确定。这项研究检查了儿童fUTI的最佳治疗持续时间。
方法：我们创建了一个使用发热持续时间来确定抗生素给药持续时间的方案。经静脉施用抗生素直至发热消退后3天，随后口服抗生素1周。fUTI的诊断是基于37.5°C或更高的发烧，并且导管尿液的定量培养产生的细菌计数≥5×104。根据对比增强计算机断层扫描（eCT）结果诊断出急性局灶性细菌性肾炎（AFBN）和肾盂肾炎（PN）。我们回顾性回顾了治疗结果。
结果：在根据我们的方案治疗的78例患者中，分析了来自58名儿童的数据-49名儿童（30名男孩）患有PN，9名（3名男孩）患有AFBN。血液检测结果显示，AFBN患者的白细胞计数和C反应蛋白水平明显高于PN患者；然而，两组之间的尿检结果和致病菌没有差异.AFBN患者的发烧消退时间和静脉注射抗生素的持续时间明显长于PN患者。然而,AFBN治疗的平均持续时间为14.2天，这比以前报道的3周的给药期短。在AFBN患者中未观察到复发。
结论：使用发热持续时间来确定抗菌治疗持续时间的方案是有用的。侵入性检查,如ECT，不是必需的。
方法：我们创建了一个使用发热持续时间来确定抗生素给药持续时间的方案。经静脉施用抗生素直至发热消退后3天，随后口服抗生素1周。fUTI的诊断是基于37.5°C或更高的发烧，并且导管尿液的定量培养产生的细菌计数≥5×104。根据对比增强计算机断层扫描（eCT）结果诊断出急性局灶性细菌性肾炎（AFBN）和肾盂肾炎（PN）。我们回顾性回顾了治疗结果。
结果：在根据我们的方案治疗的78例患者中，分析了来自58名儿童的数据-49名儿童（30名男孩）患有PN，9名（3名男孩）患有AFBN。血液检测结果显示，AFBN患者的白细胞计数和C反应蛋白水平明显高于PN患者；然而，两组之间的尿检结果和致病菌没有差异.AFBN患者的发烧消退时间和静脉注射抗生素的持续时间明显长于PN患者。然而,AFBN治疗的平均持续时间为14.2天，这比以前报道的3周的给药期短。在AFBN患者中未观察到复发。
结论：使用发热持续时间来确定抗菌治疗持续时间的方案是有用的。侵入性检查,如ECT，不是必需的。
