Simões E Silva Ana Cristina, Oliveira Eduardo A, Mak Robert H
Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
J Pediatr (Rio J). 2020 Mar-Apr;96 Suppl 1(Suppl 1):65-79. doi: 10.1016/j.jped.2019.10.006. Epub 2019 Nov 26.
This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients.
Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases.
Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection.
Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.
本综述旨在对小儿尿路感染的发病机制、临床表现、诊断、影像学检查、治疗、化学预防及并发症进行批判性概述。
由两位作者独立获取数据，他们在公共数据库中进行了全面而非系统性的检索。
尿路感染是儿童最常见的细菌感染。小儿尿路感染可能是先天性肾和尿路畸形（CAKUT）的早期临床表现，或与膀胱功能障碍有关。大肠杆菌导致80%-90%的社区获得性急性肾盂肾炎发作，尤其是在儿童中。细菌毒力因子和宿主天然免疫系统可能导致尿路感染的发生和严重程度。儿童尿路感染的临床表现高度异质，症状可能相当隐匿。尿培养仍是诊断尿路感染的金标准，各中心的尿液采集方法应根据自行排尿标本的准确性来确定。关于理想影像学检查方案的争论仍在继续，且有减少预防用药的趋势。应强调复发性尿路感染危险因素的替代措施和管理。然而，在特定患者中，预防可防止复发性尿路感染及其长期后果。根据基于人群的研究，高血压和慢性肾脏病很少与尿路感染相关。
关于儿童尿路感染的许多方面仍存在争议，尤其是影像学检查和抗生素预防的指征。需要进一步的纵向研究来制定儿童尿路感染的个性化治疗方法。
