Schroeder Alan R, Abidari Jennifer M, Kirpekar Rashmi, Hamilton John R, Kang Young S, Tran VyThao, Harris Stephen J
Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
Arch Pediatr Adolesc Med. 2011 Nov;165(11):1027-32. doi: 10.1001/archpediatrics.2011.178.
To determine the impact of using an algorithm requiring selective rather than routine urinary tract imaging following a first febrile urinary tract infection (UTI) on imaging use, detection of vesicoureteral reflux (VUR), prophylactic antibiotic use, and UTI recurrence within 6 months.
Retrospective review comparing outcomes during periods before algorithm use (September 1, 2006, to August 31, 2007) and after algorithm use (September 1, 2008, to August 31, 2009). The new algorithm, which adapted recommendations from the United Kingdom's National Institute for Health and Clinical Excellence 2007 guidelines, was implemented in 2008. The algorithm calls for renal ultrasonography in most cases and restricts voiding cystourethrography for use in patients with certain risk factors.
County health system.
Children younger than 2 years with a first febrile UTI.
Selective algorithm for urinary tract imaging.
Urinary tract imaging use, detection of VUR, prophylactic antibiotic use, and UTI recurrence within 6 months.
After introduction of the new algorithm, voiding cystourethrography and prophylactic antibiotic use decreased markedly. Rates of UTI recurrence within 6 months and detection of grades 4 and 5 VUR did not change, but detection of grades 1 to 3 VUR decreased substantially. Patients in the prealgorithm group with grades 1 to 3 VUR who would have been missed with selective screening underwent no interventions other than successive urinary tract imaging and prophylactic antibiotic use.
By restricting urinary tract imaging after an initial febrile UTI, rates of voiding cystourethrography and prophylactic antibiotic use decreased substantially without increasing the risk of UTI recurrence within 6 months and without an apparent decrease in detection of high-grade VUR. Clinicians can be more judicious in their use of urinary tract imaging.
确定在首次发热性尿路感染（UTI）后使用一种要求进行选择性而非常规尿路成像的算法，对成像检查的使用、膀胱输尿管反流（VUR）的检测、预防性抗生素的使用以及6个月内UTI复发情况的影响。
回顾性研究，比较算法使用前（2006年9月1日至2007年8月31日）和算法使用后（2008年9月1日至2009年8月31日）的结果。新算法于2008年实施，采用了英国国家卫生与临床优化研究所2007年指南中的建议。该算法在大多数情况下要求进行肾脏超声检查，并限制在有特定风险因素的患者中使用排尿性膀胱尿道造影。
县卫生系统。
2岁以下首次发热性UTI的儿童。
尿路成像的选择性算法。
尿路成像的使用、VUR的检测、预防性抗生素的使用以及6个月内UTI复发情况。
引入新算法后，排尿性膀胱尿道造影和预防性抗生素的使用显著减少。6个月内UTI复发率以及4级和5级VUR的检测率没有变化，但1至3级VUR的检测率大幅下降。算法使用前有1至3级VUR且通过选择性筛查会漏诊的患者，除了连续进行尿路成像和使用预防性抗生素外，未接受其他干预措施。
通过在首次发热性UTI后限制尿路成像，排尿性膀胱尿道造影和预防性抗生素的使用率大幅降低，同时在6个月内不增加UTI复发风险，且高级别VUR的检测率没有明显下降。临床医生在使用尿路成像时可以更加审慎。
