University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania.
Wayne State University, Children's Hospital of Michigan, Detroit.
JAMA Pediatr. 2016 Sep 1;170(9):848-54. doi: 10.1001/jamapediatrics.2016.1181.
Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent.
To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections (UTIs) is associated with the occurrence and severity of renal scarring.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study that combined data from 2 previously conducted longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study). Children younger than 6 years with a first or second UTI were followed up for 2 years.
Duration of the child's fever prior to initiation of antimicrobial therapy for the index UTI.
New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan (obtained at study exit) that was not present on the baseline scan.
Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal scarring. Delay in the initiation of antimicrobial therapy was associated with renal scarring; the median (25th, 75th percentiles) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (P = .003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal scarring. Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables.
Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.
现有数据表明，抗菌治疗开始时间延迟与肾瘢痕形成之间的关系并不一致。
确定发热性尿路感染（UTI）抗菌治疗开始时间的延迟是否与肾瘢痕的发生和严重程度相关。
设计、设置和参与者：回顾性队列研究，结合了两项先前进行的纵向研究（随机干预儿童膀胱输尿管反流试验和谨慎尿路感染评估研究）的数据。6 岁以下的首次或第二次 UTI 患儿接受了 2 年的随访。
患儿发热至开始治疗首次 UTI 的时间。
新出现的肾瘢痕定义为在研究结束时进行的晚 dimercaptosuccinic 酸肾扫描（LS）上出现光密度降低加轮廓改变，而基线扫描上不存在。
在纳入分析的 482 名儿童中，434 名女性（90%），375 名白人（78%），375 名有膀胱输尿管反流（78%）。中位年龄为 11 个月。共有 35 名儿童（7.2%）出现新的肾瘢痕。抗菌治疗开始时间的延迟与肾瘢痕相关；有肾瘢痕和无肾瘢痕的患儿开始抗生素治疗前发热的中位（25 百分位，75 百分位）时间分别为 72（30，120）和 48（24，72）小时（P = .003）。年龄较大（OR，1.03；95%CI，1.01-1.05）、西班牙裔（OR，5.24；95%CI，2.15-12.77）、复发性尿路感染（OR，0.97；95%CI，0.27-3.45）和膀胱肠道功能障碍（OR，6.44；95%CI，2.89-14.38）也与新出现的肾瘢痕相关。即使在调整了这些变量后，抗菌治疗开始时间的延迟与肾瘢痕之间仍存在显著相关性。
发热性 UTI 治疗延迟与永久性肾瘢痕形成相关。在发热患儿中，临床医生不应延迟 UTI 的检测。
