Cohen R, Gillet Y, Faye A
Centre Hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
Arch Pediatr. 2012 Nov;19 Suppl 3:S124-8. doi: 10.1016/S0929-693X(12)71285-X.
Management of urinary tract infections (UTI) in children is at a crossroads both in regard to the diagnostic methods used, the need to detect vesico-ureteral reflux, the benefit of prophylactic antibiotics and the emergence strains of multiresistant E. coli. The Groupe de Pathologie Infectieuse Pédiatrique of French Society of Pediatrics takes position : (i) to utilize more frequently urinary dipsticks and for urinary cultures, other methods of urine sampling than bag (sample jet, urethral catheterization, supra-pubic puncture) ; (ii) do not alter the initial therapeutic proposals of the former AFSSAPS (despite the percentage of E. coli ESBL around 10 %), but now, as soon as possible to recover the result of susceptibility testing to quickly change (for effective antibiotic treatment against a resistant strain) and to increase the proportion of children receiving initial treatment with aminoglycosides monotherapy (which remains active on the majority of ESBL strains); (iii) to reduce the prescription of antibiotic prophylaxis and retrograde cystography, except in special circumstances (recurrence, major abnormalities on ultrasound).
儿童尿路感染（UTI）的管理正处于十字路口，涉及所用的诊断方法、检测膀胱输尿管反流的必要性、预防性使用抗生素的益处以及多重耐药大肠杆菌菌株的出现。法国儿科学会感染性病理儿科小组表明立场：（i）更频繁地使用尿试纸进行检测，并在进行尿培养时，采用除尿袋采集外的其他尿液采样方法（采样喷射、尿道插管、耻骨上穿刺）；（ii）不改变前法国药品安全局（AFSSAPS）最初的治疗建议（尽管产超广谱β-内酰胺酶大肠杆菌的比例约为10%），但现在要尽快获取药敏试验结果，以便迅速调整（针对耐药菌株进行有效的抗生素治疗），并增加接受氨基糖苷类单药初始治疗的儿童比例（氨基糖苷类对大多数产超广谱β-内酰胺酶菌株仍有活性）；（iii）减少抗生素预防性使用和逆行膀胱造影的处方，特殊情况（复发、超声检查有重大异常）除外。
