Sureshkumar Premala, Jones Mike, Cumming Robert G, Craig Jonathan C
Centre for Kidney Research, NHMRC Centre for Clinical Research Excellence, The Children's Hospital at Westmead, Australia.
J Paediatr Child Health. 2009 Mar;45(3):87-97. doi: 10.1111/j.1440-1754.2008.01435.x. Epub 2009 Feb 2.
To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies.
A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional sample of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases.
Parents of 2856 children (mean age 7.3 years, range 4.8-12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1-30.4), daytime incontinence (OR 2.6, 1.6-4.5), female gender (OR 2.4, 1.5-3.8), and encopresis (OR 1.9, 1.1-3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in > or =8 year olds, 0% vs. 4% in 4-6 year olds).
Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys.
确定儿童尿路感染（UTI）的危险因素，为预防策略的制定提供依据。
向从入学前4年中随机抽取的小学生家长发放一份经过验证的问卷，内容涵盖人口统计学因素、围产期、发育、肠道和泌尿系统病史。通过家长报告确定UTI，并对所有阳性病例以及50例随机选取的阴性病例与微生物学报告进行交叉核对以验证。
2856名儿童（平均年龄7.3岁，范围4.8 - 12.8岁）的家长进行了回应。经细菌学验证，共有3.6%的儿童患有UTI，而仅根据家长报告这一比例为12.6%。多变量多分类逻辑回归显示，结构性肾脏异常病史（比值比（OR）15.7，95%置信区间8.1 - 30.4）、日间尿失禁（OR 2.6，1.6 - 4.5）、女性性别（OR 2.4，1.5 - 3.8）和大便失禁（OR 1.9，1.1 - 3.4）与UTI独立相关。日间尿失禁在男孩中增加UTI风险的程度（8.3%对1.2%）高于女孩（8.1%对4.6%），肾脏问题在年龄较大儿童中增加UTI风险的程度高于年龄较小儿童（≥8岁儿童中为29%对2%，4 - 6岁儿童中为0%对4%）。
家长对UTI的报告高估了约三倍。有效治疗日间尿失禁和大便失禁可能预防儿童尤其是男孩的UTI。
