Seguias Luis, Srinivasan Karthik, Mehta Amit
University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
Hosp Pediatr. 2012 Jul;2(3):161-6. doi: 10.1542/hpeds.2012-0010.
The objective of this retrospective series is to describe the demographics and treatment of patients with renal abscesses and to determine if abscess size influences management.
We reviewed all pediatric cases of renal abscesses treated over a 10-year period in our medical center. Clinical, laboratory, imaging data, and treatment modalities were analyzed.
Thirty-six patients were evaluated, with renal abscesses found in all age groups. The median age was 9.3 years, and 64% of patients affected were female. Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 310/a of patients. Previous urinary tract infection was documented in 31% of the cases. Initial elevation of C-reactive protein or erythrocyte sedimentation rate, when obtained, was observed in >80% of cases. Abnormal urinalysis was recognized in two-thirds of encounters. Escherichia coli, the most common microorganism isolated, was found in half the cases. Staphylococcus aureus was isolated in 11%. Ultrasound and computed tomography were the most used diagnostic imaging modalities. Eighty-nine percent of the patients who received intravenous antibiotics alone as an initial treatment regimen did not require percutaneous drainage or surgery.
Ten of the 14 patients with an abscess size > or =3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size <3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.
本回顾性系列研究旨在描述肾脓肿患者的人口统计学特征及治疗情况，并确定脓肿大小是否会影响治疗管理。
我们回顾了在我们医疗中心10年间治疗的所有小儿肾脓肿病例。分析了临床、实验室、影像学数据及治疗方式。
共评估了36例患者，各年龄组均发现有肾脓肿。中位年龄为9.3岁，64%的患者为女性。发热和腹痛是最常见的临床症状。31%的患者存在病前泌尿生殖系统疾病。31%的病例有既往尿路感染记录。若进行检测，超过80%的病例最初C反应蛋白或红细胞沉降率升高。三分之二的病例尿常规异常。分离出的最常见微生物为大肠杆菌，半数病例中发现该菌。金黄色葡萄球菌分离率为11%。超声和计算机断层扫描是最常用的诊断成像方式。仅接受静脉抗生素作为初始治疗方案的患者中，89%不需要经皮引流或手术。
14例脓肿大小≥3 cm的患者中有10例接受了侵入性干预，但这10例中只有1例最初单独进行了48小时抗生素试验。相比之下，22例脓肿大小<3 cm的患者中只有2例接受了侵入性干预（Fisher P = .0002）。我们得出结论，静脉抗生素保守治疗可能是一种合理的初始方法。
