Nuutinen M, Uhari M, Murphy M F, Hey K
Department of Pediatrics, University of Oulu, Finland.
Pediatr Nephrol. 1999 Jan;13(1):45-9. doi: 10.1007/s004670050560.
In order to evaluate the effect of the introduction of recent similar guidelines on the treatment of acute urinary tract infection (UTI) in children, and possible changes in its epidemiology, we analyzed the records of hospital discharge for acute UTI under the age of 15 years in England and Wales between 1979 and 1993 and in Finland between 1978 and 1994. Cases were defined by the ICD9 diagnostic codes 590.1 (acute pyelonephritis) and 599.0 (UTI, site not specified) for males and females according to three age groups (0-4, 5-9, and 10-14 years). We also compared the registry data on kidney transplants due to end-stage renal disease caused by recurrent pyelonephritis in the United Kingdom and Finland. In England the rate of attack of symptomatic UTI per 1,000 girls under 15 years increased from 0.74 (95% confidence interval 0.71-0.76) in 1987 to 1.32 (1.29-1.35) in 1993 (P < 0.001, test for trend). The respective figures for Finnish girls were 1.74 (1.62-1.86) in 1987 and 1.62 (1.51-1.74) in 1993 (P = 0.72). In English boys, the increase in the attack rate was from 0.38 (0.36-0.40) in 1987 to 0.70 (0.68-0.73) in 1993 (P < 0.001). In Finnish boys the respective figures were 0.74 (0.66-0.82) in 1987 and 0.88 (0.80-0.97) in 1993 (P < 0.02). The observed increases in the attack rates of UTI most probably relate to increased referral of acute UTI patients to hospitals for the recommended imaging studies rather than changing occurrence. Publication of guidelines for treatment of UTI in children, consolidating more-general awareness, may have contributed to this. The mean annual numbers of kidney transplants in the United Kingdom and Finland during 1989-1995 due to end-stage renal disease caused by pyelonephritis were of similar magnitude, i.e., 1.9 (1.6-2.3) transplants per million inhabitants in the United Kingdom and 2.8 (1.5-4.7) transplants per million inhabitants in Finland. The decreasing trend in these figures in both countries, although statistically significant only in the United Kingdom (P < 0.05, test for trend), suggests improved longterm outcome of these patients induced by better diagnosis and treatment of pyelonephritis and the diseases related to it, such as congenital malformations. According to our data, valid clinical guidelines are effective in changing clinical practice.
为了评估引入近期类似指南对儿童急性尿路感染（UTI）治疗的效果及其流行病学可能发生的变化，我们分析了1979年至1993年英格兰和威尔士以及1978年至1994年芬兰15岁以下急性UTI的医院出院记录。根据国际疾病分类第九版（ICD9）诊断代码590.1（急性肾盂肾炎）和599.0（UTI，部位未指明），按三个年龄组（0 - 4岁、5 - 9岁和10 - 14岁）对男性和女性病例进行定义。我们还比较了英国和芬兰因复发性肾盂肾炎导致终末期肾病而进行肾移植的登记数据。在英格兰，15岁以下女童有症状UTI的发病率从1987年的每1000人0.74（95%置信区间0.71 - 0.76）增至1993年的1.32（1.29 - 1.35）（P < 0.001，趋势检验）。芬兰女童的相应数字分别为1987年的1.74（1.62 - 1.86）和1993年的1.62（1.51 - 1.74）（P = 0.72）。在英格兰男童中，发病率从1987年的0.38（0.36 - 0.40）增至1993年的0.70（0.68 - 0.73）（P < 0.001）。芬兰男童的相应数字分别为1987年的0.74（0.66 - 0.82）和1993年的0.88（0.80 - 0.97）（P < 0.02）。观察到的UTI发病率增加很可能与急性UTI患者因推荐的影像学检查而更多地转诊至医院有关，而非发病率的改变。儿童UTI治疗指南的发布强化了更普遍的认识，可能对此起到了推动作用。1989 - 1995年期间，英国和芬兰因肾盂肾炎导致终末期肾病而进行肾移植的年均数量规模相近，即英国每百万居民中有1.9（1.6 - 2.3）例肾移植，芬兰每百万居民中有2.8（1.5 - 4.7）例肾移植。两国这些数字的下降趋势，尽管仅在英国具有统计学意义（P < 0.05，趋势检验），提示对肾盂肾炎及其相关疾病（如先天性畸形）的更好诊断和治疗改善了这些患者的长期预后。根据我们的数据，有效的临床指南能有效改变临床实践。
