治疗小儿复发性复杂性尿路感染伴膀胱输尿管反流。

Treatment of recurrent complicated urinary tract infections in children with vesicoureteral reflux.

机构信息

Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan.

Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Hungkuang University, Taichung, Taiwan.

出版信息

J Microbiol Immunol Infect. 2016 Oct;49(5):717-722. doi: 10.1016/j.jmii.2014.08.024. Epub 2014 Nov 21.

DOI:10.1016/j.jmii.2014.08.024

PMID:25442872

Abstract

BACKGROUND

Urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR) are often caused by uropathogens with a high rate of drug resistance and are associated with a high rate of recurrence with a single pathogen. In this study, we evaluated the incidence of recurrent UTI and the drug resistance pattern of Escherichia coli in children with VUR. We also evaluated whether combination therapy comprising fosomycin plus one other antimicrobial agent is effective for treatment of recurrent UTIs.

METHODS

We retrospectively reviewed the medical records of all children with VUR who developed at least one episode of UTI during the period January 1, 2003 to December 31, 2013 at a single medical center. The effectiveness of fosfomycin plus amikicin for Enterobacteriaceae or ceftazidime for Pseudomonas aeruginosa infections was prospectively studied in six children with recurrent relapsing UTIs.

RESULTS

The study population comprised 129 children (age range, from 1month to 15 years; mean ± standard deviation, 2.37 ± 2.91 years) with VUR who developed at least one UTI during the 10-year study period; 68 (52.7%) had recurrent UTIs. The presence of an underlying urinary tract anomaly was predictive of recurrence (p = 0.028). The rates of susceptibility of E. coli to cefazolin (p < 0.001) and cefotaxime (p < 0.001) were significantly lower in patients with recurrent UTIs. Combination therapy with fosfomycin plus amikacin or ceftazidime was shown to be an effective therapeutic option for recurrent UTIs due to a single uropathogen.

CONCLUSION

The rates of susceptibility of E. coli to commonly used antimicrobials were significantly lower in children who developed more than one episode of UTI. The empiric choice of cefazolin or cefotaxime was usually ineffective. Administration of fosfomycin plus amikacin or ceftazidime was an effective therapeutic and preventive strategy in children with VUR and recurrent relapsing UTI.

摘要

背景

患有膀胱输尿管反流（VUR）的儿童的尿路感染（UTI）通常由耐药率较高的尿路病原体引起，且单一病原体引起的复发率较高。在这项研究中，我们评估了 VUR 患儿 UTI 的复发率和大肠埃希菌的耐药模式。我们还评估了磷霉素联合另一种抗菌药物的联合治疗方案是否对治疗复发性 UTI 有效。

方法

我们回顾性分析了 2003 年 1 月 1 日至 2013 年 12 月 31 日期间在一家医疗中心就诊的所有至少发生过一次 UTI 的 VUR 患儿的病历。我们前瞻性研究了磷霉素联合阿米卡星治疗肠杆菌科或头孢他啶治疗铜绿假单胞菌感染，以及 6 例复发性反复发作性 UTI 患儿的疗效。

结果

研究人群包括 129 名 VUR 患儿（年龄 1 个月至 15 岁；平均 ± 标准差 2.37 ± 2.91 岁），在 10 年研究期间至少发生过一次 UTI；68 例（52.7%）患儿发生了复发性 UTI。存在下尿路畸形是复发的预测因素（p = 0.028）。对头孢唑林（p < 0.001）和头孢噻肟（p < 0.001）的敏感性较低的大肠埃希菌的发生率在复发性 UTI 患者中明显较低。磷霉素联合阿米卡星或头孢他啶的联合治疗方案对单一尿路病原体引起的复发性 UTI 是一种有效的治疗选择。