背景:探讨儿童肾脓肿并发急性肾盂肾炎的诊断和治疗方法。
方法:两名儿童出现发烧,呕吐,没有典型表现的腹痛,比如尿频,紧迫性,排尿困难,血尿,泡沫尿液,还有腰痛.通过B超和计算机断层扫描增强诊断并发急性肾盂肾炎的肾脓肿。此外,炎症标志物显著升高,但血常规和尿培养反复呈阴性。经验性抗感染治疗效果不明显。病例2确诊为致病性诊断,血液和尿液中的宏基因检测指导后续治疗。
方法:两名患儿入院时被诊断为急性胃肠炎,但影像学检查诊断为并发急性肾盂肾炎的肾脓肿。
方法:两组患儿均给予第三代头孢菌素抗感染治疗,没有明显的效果。血、尿常规培养反复阴性。病例1改为哌拉西林他唑巴坦钠。我们进一步对案例2进行了血液和尿宏基因组下一代测序检测。同时,给予美罗培南和利奈唑胺抗感染治疗。结果显示大肠埃希菌和粪肠球菌重叠感染。根据基因检测结果,出院后服用阿莫西林克拉维酸钾联合呋喃妥因。
结果:2例患儿临床症状消失,感染得到控制,影像学显示肾脓肿合并急性肾盂肾炎消失。
结论:急性肾盂肾炎并发肾脓肿的临床谱不明确,没有具体的表现,很容易被误诊.B超和计算机断层扫描增强有助于做出明确的诊断。此外,常规培养的敏感性较低,和宏基因组下一代测序可能有助于检测病原微生物和指导治疗。使用广谱抗生素的早期治疗可能会产生有利的结果。
BACKGROUND: To describe the diagnostic and treatment approaches of renal abscesses complicated with acute
pyelonephritis in children.
METHODS: Two children presented with fever, vomiting, and abdominal pain with no typical manifestations, like frequent urination, urgency, dysuria, hematuria, foam urine, and lumbago. Renal abscess complicating acute
pyelonephritis was diagnosed by B-ultrasound and computed tomography enhancement. Moreover, inflammatory markers were elevated significantly, but routine blood and urine cultures were repeatedly negative. The empirical anti-infection therapy had no obvious effect. A pathogenic diagnosis was confirmed in case two, and macro gene detection in blood and urine guided the follow-up treatment.
METHODS: Both children were diagnosed with acute gastroenteritis on admission, but renal abscess complicating acute
pyelonephritis were diagnosed by imaging examination.
METHODS: Both children were given anti-infection therapy of third-generation cephalosporin, which had no obvious effect. Routine blood and urine cultures were repeatedly negative. Case one was changed to piperacillin sodium tazobactam. We further carried out blood and urinary metagenomic next-generation sequencing detection for case two. Meanwhile, meropenem and linezolid anti-infection treatment was given. The results showed overlapping infection with Escherichia coli and Enterococcus faecalis. According to the genetic test results, amoxicillin clavulanate potassium combined with nitrofurantoin were prescribed after discharge.
RESULTS: Clinical symptoms of the 2 children disappeared, the infection was controlled, and imaging showed that renal abscess complicated with acute
pyelonephritis disappeared.
CONCLUSIONS: The clinical spectrum of renal abscess complicating acute
pyelonephritis is vague, with no specific manifestations, and can be easily misdiagnosed. B-ultrasound and computed tomography enhancement are helpful in making a definite diagnosis. Moreover, the sensitivity of routine culture is low, and metagenomic next-generation sequencing might be helpful to detect pathogenic microorganisms and guided treatment. Early treatment with broad-spectrum antibiotics might have favorable outcomes.