PDF(Pubmed)
Abstract：
OBJECTIVE: Most children with uncomplicated urinary tract infections (UTI) can be managed with oral antibiotics. However, identifying those likely to fail oral and need intravenous antibiotics due to complicating features at presentation is challenging. We aimed to derive, validate and test a score to guide initial antibiotic route.
METHODS: This cohort study enrolled children both prospectively and retrospectively. Patients were divided into two groups based on whether they received intravenous or oral antibiotics after 24 hours, including those who switched between routes. Children diagnosed with confirmed UTI were used to derive then validate the score, comparing complicating clinical features between the two groups. Combinations of significantly differentiating features generated receiver operating characteristic curves and the optimal cut-off for intravenous antibiotic use was selected.
METHODS: The emergency department of a tertiary paediatric hospital.
METHODS: All children aged 3 months-17 years with suspected UTI were eligible, and were included if they fulfilled the diagnostic criteria for UTI.
METHODS: The effectiveness of the derived clinical score to differentiate patients at presentation who had complicated UTI requiring ongoing intravenous antibiotics.
RESULTS: There were 1240 patients, of whom 167 children aged 12 months-11 years with confirmed UTI comprised the derivation cohort. The combination of features that performed optimally (area under curve 0.85, 95% CI 0.79 to 0.91) were: rigors, urological abnormality, fever (≥38°C), emesis, recurrent (≥3) UTI, tachycardia: the RUPERT score (1 point each, maximum 6). A score ≥3 accurately classified route of antibiotics after 24 hours for 80% patients (sensitivity 77%, specificity 81%). For the 168 patients in the validation cohort, the score accurately classified 76% (sensitivity 67%, specificity 78%). The score tested well in \'probable\' UTI and adolescents, and less well in infants.
CONCLUSIONS: The Melbourne RUPERT score provides the first standardised, easy-to-use score to aid clinicians in deciding route of antibiotics for more complicated UTI in children. It now needs prospective validation.
METHODS: This cohort study enrolled children both prospectively and retrospectively. Patients were divided into two groups based on whether they received intravenous or oral antibiotics after 24 hours, including those who switched between routes. Children diagnosed with confirmed UTI were used to derive then validate the score, comparing complicating clinical features between the two groups. Combinations of significantly differentiating features generated receiver operating characteristic curves and the optimal cut-off for intravenous antibiotic use was selected.
METHODS: The emergency department of a tertiary paediatric hospital.
METHODS: All children aged 3 months-17 years with suspected UTI were eligible, and were included if they fulfilled the diagnostic criteria for UTI.
METHODS: The effectiveness of the derived clinical score to differentiate patients at presentation who had complicated UTI requiring ongoing intravenous antibiotics.
RESULTS: There were 1240 patients, of whom 167 children aged 12 months-11 years with confirmed UTI comprised the derivation cohort. The combination of features that performed optimally (area under curve 0.85, 95% CI 0.79 to 0.91) were: rigors, urological abnormality, fever (≥38°C), emesis, recurrent (≥3) UTI, tachycardia: the RUPERT score (1 point each, maximum 6). A score ≥3 accurately classified route of antibiotics after 24 hours for 80% patients (sensitivity 77%, specificity 81%). For the 168 patients in the validation cohort, the score accurately classified 76% (sensitivity 67%, specificity 78%). The score tested well in \'probable\' UTI and adolescents, and less well in infants.
CONCLUSIONS: The Melbourne RUPERT score provides the first standardised, easy-to-use score to aid clinicians in deciding route of antibiotics for more complicated UTI in children. It now needs prospective validation.
摘要：
目的：大多数无并发症尿路感染（UTI）的儿童可以口服抗生素治疗。然而,识别那些可能因表现复杂而口服失败且需要静脉注射抗生素的患者具有挑战性.我们的目标是推导，验证并测试分数以指导初始抗生素途径。
方法：本队列研究前瞻性和回顾性地纳入儿童。根据患者在24小时后是否接受静脉或口服抗生素分为两组，包括那些在路线之间切换的人。确诊为UTI的儿童被用来得出然后验证分数，比较两组患者复杂的临床特征。选择了显着区分特征的组合，生成了接收器工作特征曲线和静脉抗生素使用的最佳截止值。
方法：某三级儿科医院急诊科。
方法：所有年龄在3个月至17岁的疑似尿路感染的儿童均符合资格，如果他们符合UTI的诊断标准，则将其包括在内。
方法：推导出的临床评分在区分患有复杂UTI且需要持续静脉注射抗生素的患者时的有效性。
结果：有1240例患者，其中167名12个月-11岁确诊UTI的儿童包括衍生队列.表现最佳的特征组合(曲线下面积0.85，95%CI0.79至0.91)是：严格性，泌尿系统异常,发烧（≥38°C），呕吐,复发性（≥3）UTI，心动过速：RUPERT评分（各1分，最大值6）。80%的患者在24小时后对抗生素的途径进行了评分≥3的准确分类（敏感性为77%，特异性81%)。对于验证队列中的168名患者，分数准确分类76%(敏感度67%，特异性78%)。分数在“可能的”UTI和青少年中测试良好，在婴儿中效果较差。
结论：墨尔本RUPERT评分提供了第一个标准化的，易于使用的评分，以帮助临床医生为儿童更复杂的UTI确定抗生素的使用途径。现在需要前瞻性验证。
方法：本队列研究前瞻性和回顾性地纳入儿童。根据患者在24小时后是否接受静脉或口服抗生素分为两组，包括那些在路线之间切换的人。确诊为UTI的儿童被用来得出然后验证分数，比较两组患者复杂的临床特征。选择了显着区分特征的组合，生成了接收器工作特征曲线和静脉抗生素使用的最佳截止值。
方法：某三级儿科医院急诊科。
方法：所有年龄在3个月至17岁的疑似尿路感染的儿童均符合资格，如果他们符合UTI的诊断标准，则将其包括在内。
方法：推导出的临床评分在区分患有复杂UTI且需要持续静脉注射抗生素的患者时的有效性。
结果：有1240例患者，其中167名12个月-11岁确诊UTI的儿童包括衍生队列.表现最佳的特征组合(曲线下面积0.85，95%CI0.79至0.91)是：严格性，泌尿系统异常,发烧（≥38°C），呕吐,复发性（≥3）UTI，心动过速：RUPERT评分（各1分，最大值6）。80%的患者在24小时后对抗生素的途径进行了评分≥3的准确分类（敏感性为77%，特异性81%)。对于验证队列中的168名患者，分数准确分类76%(敏感度67%，特异性78%)。分数在“可能的”UTI和青少年中测试良好，在婴儿中效果较差。
结论：墨尔本RUPERT评分提供了第一个标准化的，易于使用的评分，以帮助临床医生为儿童更复杂的UTI确定抗生素的使用途径。现在需要前瞻性验证。
