Saw A H
Department of Paediatrics, Singapore General Hospital.
Singapore Med J. 1990 Jun;31(3):266-8.
Even though urinary tract infection is common in childhood, its diagnosis and management can be difficult. One must be aware of factors that may interfere with urine culture result. Besides urinary stasis, renal tract abnormalities and detrusor instability, host factors and certain strains of invading organisms (P-fimbriated E Coli) may be important in the pathogenesis of urinary trace infection. The choice of antibiotics for treatment of urinary tract infection should be guided by the age of the patient, clinical presentation and urine culture result. The management of vesico-ureteric reflux depends on its grading. Grade I and II can be treated medically by long-term low dose antibiotics because spontaneous resolution is high. For Grade III and IV, the treatment of choice is controversial. Controlled prospective studies showed that surgical reimplantation did not prevent new scar formation, progression of old scars and breakthrough infection. Endoscopic submeteric injection of Teflon is a new method to correct vesico-ureteric reflux. Despite favourable short-term results, the long-term outcome is unknown.
尽管尿路感染在儿童时期很常见，但其诊断和管理可能具有挑战性。必须了解可能干扰尿培养结果的因素。除了尿路淤滞、肾道异常和逼尿肌不稳定外，宿主因素和某些侵袭性生物体菌株（P菌毛大肠杆菌）在尿路感染的发病机制中可能也很重要。治疗尿路感染的抗生素选择应根据患者年龄、临床表现和尿培养结果来指导。膀胱输尿管反流的管理取决于其分级。I级和II级可通过长期低剂量抗生素进行药物治疗，因为自发缓解率很高。对于III级和IV级，治疗选择存在争议。对照前瞻性研究表明，手术再植并不能预防新瘢痕形成、旧瘢痕进展和突破性感染。内镜下注射聚四氟乙烯是纠正膀胱输尿管反流的一种新方法。尽管短期效果良好，但其长期结果尚不清楚。
