Sakran W, Miron D, Halevy R, Colodner R, Smolkin V, Koren A
Pediatric Department B, HaEmek Medical Center, Afula.
Harefuah. 2003 Apr;142(4):249-52, 320, 319.
Urinary tract infection (UTI) is one of the most common diseases in children. Vesicoureteral reflux (VUR) has been demonstrated in a substantial number of young children with UTI. Empiric antibacterial therapy is recommended before results of the urine culture are available in order to shorten the duration of the disease and prevent renal complications.
The aims of this study were to assess the prevalence and susceptibility patterns of UTI pathogens, and urinary anomalies in children admitted with UTI.
The study population included 151 children younger than 14 years admitted with first UTI. Renal ultrasound was performed in all the patients and voiding cystourethrography (VCUG) in children younger than 5 years. Dimercaptosuccinic acid (DMSA) scan was performed in children with vesicoureteral reflux. The data included age, sex, symptoms and signs, urinalysis, the pathogen and its sensitivity and the results of the imaging studies.
A total of 119 patients (79%) were females. Gram negative rods caused 98% of the infections, of which Escherichia coli (87%) was the most prevalent pathogen, followed by Klebsiella pneumoniae (4%), and Proteus mirabilis (4%). The sensitivities to antibacterial agents were: Amikacin 100%, ceftazidime 97%, gentamicin 96%, ceftriaxone 96%, cefuroxime 95%, amoxicillin-clavulanate 84%, trimethoprim-sulfamethoxazole 63%, cephalexin 58%, and ampicillin 28%. Renal US showed minor abnormalities in 24/149 (16%) and VCUG demonstrated vesicoureteral reflux in 38/127 (30%) patients. DMSA revealed renal scars in 7/28 (25%) children with vesicoureteral reflux.
Overall Gram negative rods cause 98% of the UTI in hospitalized children in our area. E. coli is the leading pathogen and aminoglycosides and second or third generation cephalosporins are the most suitable agents for empiric therapy in UTI. A high incidence of renal scars in young children with vesicoureteral reflux was found.
尿路感染（UTI）是儿童最常见的疾病之一。大量患UTI的幼儿已被证实存在膀胱输尿管反流（VUR）。在获得尿培养结果之前，建议进行经验性抗菌治疗，以缩短病程并预防肾脏并发症。
本研究的目的是评估UTI病原体的患病率和药敏模式，以及UTI患儿的泌尿系统异常情况。
研究人群包括151名14岁以下首次因UTI入院的儿童。所有患者均进行了肾脏超声检查，5岁以下儿童进行了排尿性膀胱尿道造影（VCUG）。对存在膀胱输尿管反流的儿童进行了二巯基丁二酸（DMSA）扫描。数据包括年龄、性别、症状和体征、尿液分析、病原体及其药敏情况以及影像学检查结果。
共有119例患者（79%）为女性。革兰氏阴性杆菌引起了98%的感染，其中大肠杆菌（87%）是最常见的病原体，其次是肺炎克雷伯菌（4%）和奇异变形杆菌（4%）。对抗菌药物的敏感性分别为：阿米卡星100%、头孢他啶97%、庆大霉素96%、头孢曲松96%、头孢呋辛95%、阿莫西林-克拉维酸84%、甲氧苄啶-磺胺甲恶唑63%、头孢氨苄58%、氨苄西林28%。肾脏超声显示149例中有24例（16%）有轻微异常，VCUG显示127例中有38例（30%）患者存在膀胱输尿管反流。DMSA显示28例存在膀胱输尿管反流的儿童中有7例（25%）有肾瘢痕。
总体而言，革兰氏阴性杆菌导致了我们地区住院儿童98%的UTI。大肠杆菌是主要病原体，氨基糖苷类药物和第二代或第三代头孢菌素是UTI经验性治疗最适合的药物。发现存在膀胱输尿管反流的幼儿肾瘢痕发生率较高。
