Cohen R, Raymond J, Launay E, Gillet Y, Minodier P, Dubos F, Grimprel E
Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur des Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie (GPIP), Saint-Maur des Fossés, France.
Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie (GPIP), Saint-Maur des Fossés, France; Université Paris Descartes, Hôpital Cochin, Bactériologie, Paris, France.
Arch Pediatr. 2017 Dec;24(12S):S22-S25. doi: 10.1016/S0929-693X(17)30514-6.
Urinary tract infections are the most frequent documented bacterial infections in children. The antibiotic choices proposed in this manuscript are based on the guidelines published by the Pediatric Infectious Disease Group (GPIP) and the French-Language Infectious Disease Society (SPILF). Dipstick positive for leukocytes and/or nitrites must precede in most circumstances (excluding the newborns, neutropenic patients and those with sepsis), urine culture and antibiotic prescription. The proportion of extended-spectrum β-lactamase (ESBL) Escherichia coli strains has increased steadily in recent years, and the situations in which oral antibiotic switch is frequently not available are increasing. Cephalosporin resistance remains below 10% in most regions of France. However, there is no doubt that the proportion of resistant strains will increase in the coming years: the only uncertainly concerns the speed of this trend. With the aim of saving penems and promoting outpatient care, this guide proposes among the acceptable initial treatments for febrile urinary tract infections in infants, amikacin. This aminoglycoside remains active against the majority of ESBL strains and can be prescribed in once-daily dose allowing also ambulatory management of patients from pediatric emergency department.
尿路感染是儿童中记录最频繁的细菌感染。本手稿中提出的抗生素选择基于儿科传染病小组（GPIP）和法语传染病协会（SPILF）发布的指南。在大多数情况下（不包括新生儿、中性粒细胞减少患者和败血症患者），在进行尿培养和抗生素处方之前，尿试纸白细胞和/或亚硝酸盐检测必须呈阳性。近年来，产超广谱β-内酰胺酶（ESBL）的大肠杆菌菌株比例稳步上升，口服抗生素更换频繁不可用的情况也在增加。在法国的大多数地区，头孢菌素耐药率仍低于10%。然而，毫无疑问，未来几年耐药菌株的比例将会增加：唯一不确定的是这一趋势的速度。为了节省碳青霉烯类药物并促进门诊治疗，本指南在婴儿发热性尿路感染可接受的初始治疗中推荐了阿米卡星。这种氨基糖苷类药物对大多数ESBL菌株仍然有效，可以每日一次给药，也允许对儿科急诊科的患者进行门诊管理。
