Department of Pediatric Nephrology, Mehta Childrens Hospitals, Chennai 600 031, India.
Indian Pediatr. 2011 Sep;48(9):709-17.
In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with urinary tract infection (UTI). In view of emerging scientific literature, the recommendations have been reviewed.
Following a preliminary meeting in November 2010, a document was circulated among the participants to arrive at a consensus on the evaluation and management of these patients.
To revise and formulate guidelines on management of UTI in children.
The need for accurate diagnosis of UTI is emphasized due to important implications concerning evaluation and follow up. Details regarding clinical features and diagnosis, choices and duration of therapy and protocol for follow up are discussed. UTI is diagnosed on a positive culture in a symptomatic child, and not merely by the presence of leukocyturia. The need for parenteral therapy in UTI in young infants and those showing toxicity is emphasized. Patients with aysmptomatic bacteriuria do not require treatment. The importance of bowel bladder dysfunction in the causation of recurrent UTI is highlighted. Infants with the first UTI should be evaluated with micturating cystourethrography. Vesicoureteric reflux (VUR) is initially managed with antibiotic prophylaxis. The prophylaxis is continued till 1 year of age in patients with VUR grades I and II, and till 5 years in those with higher grades of reflux or until it resolves. Patients and their families are counselled about the need for early recognition and therapy of UTI. Children with VUR should be followed up with serial ultrasonography and direct radionuclide cystograms every 2 years, while awaiting resolution. Siblings of patients with VUR should be screened by ultrasonography. Children with renal scars need long term follow up on yearly basis for growth, hypertension, proteinuria, and renal size and function.
justifies: 2001 年，印度儿科肾脏病学组制定了尿路感染（UTI）患者管理指南。鉴于新兴的科学文献，对建议进行了审查。
process: 2010 年 11 月初步会议后，与会者传阅了一份文件，就这些患者的评估和管理达成共识。
objectives: 修订并制定儿童尿路感染管理指南。
recommendations: 强调准确诊断 UTI 的必要性，因为这对评估和随访有重要影响。详细讨论了临床特征和诊断、治疗选择和持续时间以及随访方案。在有症状的儿童中，阳性培养物即可诊断 UTI，而不仅仅是白细胞尿的存在。强调了在年幼婴儿和出现毒性的 UTI 中需要进行肠外治疗。无症状菌尿症患者不需要治疗。强调肠道膀胱功能障碍在复发性 UTI 中的致病作用。首次 UTI 的婴儿应进行排尿性膀胱尿道造影检查。最初采用抗生素预防来管理膀胱输尿管反流（VUR）。对于 VUR 等级 I 和 II 的患者，预防应持续到 1 岁，对于反流程度较高的患者或直至其消退为止。应向患者及其家属提供有关早期识别和治疗 UTI 的必要性的咨询。有 VUR 的儿童应通过定期超声检查和直接放射性核素膀胱造影术进行随访，等待其缓解。VUR 患者的兄弟姐妹应通过超声检查进行筛查。有肾瘢痕的儿童需要每年进行长期随访，以监测生长、高血压、蛋白尿以及肾脏大小和功能。
