Department of Urology, Aichi Children's Health and Medical Center, Obu, Japan.
J Urol. 2010 Apr;183(4):1527-31. doi: 10.1016/j.juro.2009.12.039. Epub 2010 Feb 20.
Despite the widespread application of endoscopic therapy and the debate surrounding the use of prophylactic antibiotics to treat children with vesicoureteral reflux, many pediatric urologists still favor medical management. Breakthrough infection is one of the absolute indications for surgery. Data to predict breakthrough infection are warranted to manage cases of primary reflux.
We reviewed medical records of 72 girls and 138 boys (mean +/- SD age at diagnosis 2.66 +/- 3.23 years) with primary vesicoureteral reflux who were followed with antibiotic prophylaxis at Aichi Children's Health and Medical Center. We examined multiple factors by univariate/multivariate analysis to elucidate risk factors for breakthrough infection.
Breakthrough infection developed in 59 children (28%). On univariate analysis higher reflux grade (p <0.05) and abnormal renal scan determined by (99m)technetium dimercapto-succinic acid (p <0.0001) were significantly associated with breakthrough infection. On multivariate analysis abnormal renal scan was an independent risk factor for breakthrough infection (OR 11.08, 95% CI 0.76-1.72, p <0.0001).
Abnormal renal scan is an independent risk factor for breakthrough infection. Parents and physicians should remain aware that these patients are at high risk for breakthrough infection, which potentially could lead to renal damage.
尽管内镜治疗已经广泛应用，并且关于预防性使用抗生素治疗儿童膀胱输尿管反流的争论也一直存在，但许多小儿泌尿科医生仍倾向于采用药物治疗。突破感染是手术的绝对指征之一。需要有数据来预测突破感染，以便管理原发性反流病例。
我们回顾了在爱知儿童健康与医疗中心接受抗生素预防治疗的 72 名女孩和 138 名男孩（平均诊断时年龄为 2.66 ± 3.23 岁）的原发性膀胱输尿管反流患者的病历。我们通过单因素/多因素分析检查了多种因素，以阐明突破感染的危险因素。
59 名儿童（28%）发生突破感染。单因素分析显示，较高的反流分级（p <0.05）和 99m 锝二巯丁二酸（99mTc-DMSA）肾扫描异常（p <0.0001）与突破感染显著相关。多因素分析显示，肾扫描异常是突破感染的独立危险因素（OR 11.08，95% CI 0.76-1.72，p <0.0001）。
异常肾扫描是突破感染的独立危险因素。家长和医生应始终意识到这些患者有发生突破感染的高风险，这可能会导致肾脏损害。
