Butler Christopher C, O'Brien Kathryn, Pickles Timothy, Hood Kerenza, Wootton Mandy, Howe Robin, Waldron Cherry-Ann, Thomas-Jones Emma, Hollingworth William, Little Paul, Van Der Voort Judith, Dudley Jan, Rumsby Kate, Downing Harriet, Harman Kim, Hay Alastair D
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Cochrane Institute of Primary Care and Public Health.
Br J Gen Pract. 2015 Apr;65(633):e217-23. doi: 10.3399/bjgp15X684361.
The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown.
To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery.
Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales.
Systematic urine sampling from children aged <5 years presenting in primary care with acute illness with culture in NHS laboratories.
Of 6079 children's urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, P<0.001). Of 231 children with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; P<0.001). Children with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005).
Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism's sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed.
学龄前儿童尿路感染（UTI）的针对性治疗、偶然治疗情况及其相关康复率尚不清楚。
确定急性病患儿中UTI的发生频率及疑似情况，以及抗生素处方的详细信息、其合理性，以及这种合理性是否对症状改善和康复有影响。
在英格兰和威尔士城乡地区的基层医疗点进行的前瞻性观察队列研究。
对5岁以下在基层医疗机构因急性病就诊的儿童进行系统尿液采样，并在英国国家医疗服务体系（NHS）实验室进行培养。
在6079份儿童尿液样本中，339份（5.6%）符合UTI实验室标准，162份（47.9%）在初次会诊时被开具了抗生素。总计，576/7101（8.1%）名儿童在尿液采样前被怀疑患有UTI，其中338名UTI患儿中有107名（临床医生敏感度为31.7%）。临床怀疑有UTI时，实验室确诊UTI的儿童比未被临床怀疑时更有可能被开具抗生素（86.0%对30.3%，P<0.001）。在231名未被怀疑有UTI的儿童中，70名（30.3%）接受了偶然使用的抗生素（即因其他原因开具的抗生素）。总体而言，176名（52.1%）确诊UTI的儿童未接受任何初始抗生素治疗。临床怀疑有UTI时，病原体对所开抗生素的敏感度高于偶然治疗时（77.1%对26.0%；P<0.001）。初次会诊时被开具合适抗生素的UTI患儿比最初未被开具合适抗生素的UTI患儿症状改善稍快（3.5天对4.0天；P = 0.005）。
超过半数培养确诊UTI的儿童在初次就诊时未被开具抗生素。偶然的UTI治疗较为常见，但通常与病原体敏感度不匹配。迫切需要改进针对急性不适儿童的抗生素治疗靶向性方法。
