Division of Paediatric Urology, Department of Urology, Mainz University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey.
Eur Urol. 2015 Mar;67(3):546-58. doi: 10.1016/j.eururo.2014.11.007. Epub 2014 Dec 2.
In 30% of children with urinary tract anomalies, urinary tract infection (UTI) can be the first sign. Failure to identify patients at risk can result in damage to the upper urinary tract.
To provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI.
The recommendations were developed after a review of the literature and a search of PubMed and Embase. A consensus decision was adopted when evidence was low.
UTIs are classified according to site, episode, symptoms, and complicating factors. For acute treatment, site and severity are the most important. Urine sampling by suprapubic aspiration or catheterisation has a low contamination rate and confirms UTI. Using a plastic bag to collect urine, a UTI can only be excluded if the dipstick is negative for both leukocyte esterase and nitrite or microscopic analysis is negative for both pyuria and bacteriuria. A clean voided midstream urine sample after cleaning the external genitalia has good diagnostic accuracy in toilet-trained children. In children with febrile UTI, antibiotic treatment should be initiated as soon as possible to eradicate infection, prevent bacteraemia, improve outcome, and reduce the likelihood of renal involvement. Ultrasound of the urinary tract is advised to exclude obstructive uropathy. Depending on sex, age, and clinical presentation, vesicoureteral reflux should be excluded. Antibacterial prophylaxis is beneficial. In toilet-trained children, bladder and bowel dysfunction needs to be excluded.
The level of evidence is high for the diagnosis of UTI and treatment in children but not for imaging to identify patients at risk for upper urinary tract damage.
In these guidelines, we looked at the diagnosis, treatment, and imaging of children with urinary tract infection. There are strong recommendations on diagnosis and treatment; we also advise exclusion of obstructive uropathy within 24h and later vesicoureteral reflux, if indicated.
在 30%的尿路异常儿童中，尿路感染 (UTI) 可能是首发症状。如果未能识别出有风险的患者，可能会导致上尿路受损。
为出现 UTI 的患儿提供诊断、治疗和影像学检查建议。
在对文献进行回顾以及对 PubMed 和 Embase 进行检索后，提出了这些建议。当证据水平较低时，采用共识决策。
UTI 根据部位、发作、症状和合并症进行分类。对于急性治疗，最重要的是部位和严重程度。耻骨上抽吸或导尿尿液采样污染率低，可确诊 UTI。使用塑料袋收集尿液，如果尿沉渣白细胞酯酶和亚硝酸盐均为阴性，或显微镜分析均为无脓尿和菌尿，则可排除 UTI。对于已训练如厕的儿童，在外生殖器清洁后采集清洁中段尿样，具有良好的诊断准确性。对于发热性 UTI 患儿，应尽快开始抗生素治疗，以消除感染、预防菌血症、改善预后，并降低肾脏受累的可能性。建议行尿路超声检查以排除梗阻性尿路病变。根据性别、年龄和临床表现，应排除膀胱输尿管反流。抗菌预防是有益的。对于已训练如厕的儿童，需要排除膀胱和肠道功能障碍。
在儿童 UTI 的诊断和治疗方面，证据水平较高，但在识别有上尿路损伤风险的患者方面，影像学检查的证据水平不高。
在这些指南中，我们探讨了儿童尿路感染的诊断、治疗和影像学检查。在诊断和治疗方面有很强的建议；我们还建议在 24 小时内排除梗阻性尿路病变，并在有必要时排除膀胱输尿管反流。
