Fitzgerald Anita, Mori Rintaro, Lakhanpaul Monica
New Zealand Guidelines Group, Wellington, New Zealand.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD006943. doi: 10.1002/14651858.CD006943.pub2.
Many studies investigating covert bacteriuria in children were conducted in the 1970s, but uncertainty remains about whether treatment is beneficial, because results are mixed in terms of treatment effectiveness. It is important to establish the effectiveness of antibiotics and other treatments to eliminate infection, reduce recurrence, and prevent long-term kidney damage. It is essential that treatment benefit to individual children outweigh any harm.
This review aims to evaluate the benefits and harms of treating covert bacteriuria in children.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1988) without language restriction.Date of last search: 28 December 2011
We included randomised and quasi-randomised controlled trials that investigated any intervention for covert bacteriuria in children aged up to 18 years with culture-proven urinary tract infection (UTI) and no known urinary symptoms at the time of diagnosis.
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random-effects model and the results were expressed as risk ratios (RR) with 95% confidence intervals (95% CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes.
This review included three randomised controlled trials (RCTs) that involved 460 children (all girls). Overall, the studies were not methodologically strong. Gaps in reporting among the included studies made assessment of methodological quality challenging. One study reported that the number of children with bacteriuria was significantly reduced at follow-up six months after antibiotic treatment (RR 0.33; 95% CI 0.13 to 0.83). At follow-up two years after treatment, two studies reported that there was no evidence of a reduction in persistent bacteriuria (RR 0.32; 95% CI 0.03 to 3.44). At follow-up four to five years after initial treatment, all included studies reported that antibiotic treatment was effective in reducing the number of children with bacteriuria (RR 0.54; 95% CI 0.42 to 0.70). There were no differences in kidney growth between treated and untreated groups (MD 0.62; 95% CI -0.43 to 1.68).None of the included studies reported data on compliance or adverse effects.
AUTHORS' CONCLUSIONS: The included studies do not provide sufficient detail about the harms and benefits of treating covert bacteriuria to enable formation of reliable conclusions. It appears that antibiotic treatment for covert bacteriuria is unlikely to benefit children in the long term.
20世纪70年代开展了许多关于儿童隐匿性菌尿症的研究，但对于治疗是否有益仍存在不确定性，因为治疗效果的结果不一。确定抗生素和其他治疗方法在消除感染、减少复发以及预防长期肾脏损害方面的有效性非常重要。至关重要的是，对每个儿童的治疗益处要超过任何危害。
本综述旨在评估治疗儿童隐匿性菌尿症的益处和危害。
我们检索了Cochrane对照试验中心注册库（Cochrane图书馆中的CENTRAL）、MEDLINE（自1966年起）和EMBASE（自1988年起），无语言限制。最后检索日期：2011年12月28日
我们纳入了随机和半随机对照试验，这些试验研究了对18岁以下经培养证实患有尿路感染（UTI）且诊断时无已知泌尿系统症状的儿童隐匿性菌尿症的任何干预措施。
两位作者独立评估研究质量并提取数据。使用随机效应模型进行统计分析，结果以风险比（RR）表示，二分结局的95%置信区间（95%CI），连续结局的均值差（MD）。
本综述纳入了三项随机对照试验（RCT），涉及460名儿童（均为女孩）。总体而言，这些研究在方法学上并不严谨。纳入研究之间报告内容的差异使得评估方法学质量具有挑战性。一项研究报告称，抗生素治疗后六个月随访时，菌尿症儿童数量显著减少（RR 0.33；95%CI 0.13至0.83）。治疗后两年随访时，两项研究报告称没有证据表明持续性菌尿症减少（RR 0.32；95%CI 0.03至3.44）。初始治疗后四至五年随访时，所有纳入研究报告称抗生素治疗在减少菌尿症儿童数量方面有效（RR 0.54；95%CI 0.42至0.70）。治疗组和未治疗组之间肾脏生长无差异（MD 0.62；95%CI -0.43至1.68）。纳入研究均未报告关于依从性或不良反应的数据。
纳入研究未提供足够详细的关于治疗隐匿性菌尿症的危害和益处的信息，无法得出可靠结论。似乎抗生素治疗隐匿性菌尿症从长期来看不太可能使儿童受益。
