Piccoli Giorgina B, Consiglio V, Colla L, Mesiano P, Magnano A, Burdese M, Marcuccio C, Mezza E, Veglio V, Piccoli G
Department of Internal Medicine, University of Turin, Turin, Italy.
Int J Antimicrob Agents. 2006 Aug;28 Suppl 1:S49-63. doi: 10.1016/j.ijantimicag.2006.05.017. Epub 2006 Jul 18.
The definition of acute pyelonephritis is controversial. There are two contrasting approaches: (1) acute pyelonephritis is a severe infectious disease involving the kidney parenchyma, and specific imaging techniques are required for diagnosis; (2) acute pyelonephritis is a urinary tract infection, and diagnosis and therapy follow simplified clinical and laboratory pathways. In this study, recent randomized controlled trials (RCTs) were systematically reviewed and the diagnostic and therapeutic approaches to acute 'uncomplicated' pyelonephritis were analysed. Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) and Chinal were searched employing Mesh, Emtree and free terms on 'pyelonephritis'. Limits included human, period (1995-2004), and trials-reviews (where available). In total, 904 references and 175 full-text were retrieved; 29 were pertinent RCTs. Seven RCTs were added from reference lists (indexed on urinary tract infections). Imaging examinations were performed in 11 of 14 studies on children (diagnostic requisite in two) and in two studies on adults; scarring was not analysed in adults. Clinical definitions varied widely (fever >37.8 to >39 degrees C, culture titres 10(4) >10(5)). Studies on adults were limited to short-term end-points (microbiological sterilization, clinical improvement). Duration of therapy was 4-20 days. The trend was towards shorter periods of therapy, mainly on an outpatient basis; intravenous therapy, if performed, was usually limited to the first 1-3 days. For acute uncomplicated pyelonephritis, the tendency is towards 2 weeks of mainly oral antibiotic therapy. However, the recent literature on adults does not discriminate among different upper urinary tract infections nor does it provide data on renal scarring. While cost constraints point towards short-term therapies, further studies are needed to assess the prevalence and long-term effect of kidney scars.
急性肾盂肾炎的定义存在争议。有两种截然不同的方法：（1）急性肾盂肾炎是一种累及肾实质的严重感染性疾病，诊断需要特定的影像学技术；（2）急性肾盂肾炎是一种尿路感染，诊断和治疗遵循简化的临床和实验室路径。在本研究中，对近期的随机对照试验（RCT）进行了系统评价，并分析了急性“非复杂性”肾盂肾炎的诊断和治疗方法。使用Mesh、Emtree以及关于“肾盂肾炎”的自由词在Medline、Embase、Cochrane对照试验中央注册库（CCTR）和中国知网进行检索。限定条件包括人类、时间段（1995 - 2004年）以及试验综述（如有）。总共检索到904篇参考文献和175篇全文；其中29篇为相关的随机对照试验。从参考文献列表（索引为尿路感染）中又补充了7项随机对照试验。14项儿童研究中有11项进行了影像学检查（两项将其作为诊断必需手段），两项成人研究也进行了影像学检查；未对成人的瘢痕形成情况进行分析。临床定义差异很大（发热>37.8至>39摄氏度，培养物滴度10⁴>10⁵）。成人研究仅限于短期终点（微生物学除菌、临床改善）。治疗持续时间为4 - 20天。趋势是治疗周期缩短，主要为门诊治疗；若进行静脉治疗，通常仅限于最初1 - 3天。对于急性非复杂性肾盂肾炎，倾向于主要采用口服抗生素治疗2周。然而，近期关于成人的文献未区分不同的上尿路感染，也未提供肾瘢痕形成的数据。虽然成本限制表明应采用短期治疗，但仍需要进一步研究来评估肾瘢痕的发生率和长期影响。
