Suh Woosuck, Kim Bi Na, Kang Hyun Mi, Yang Eun Ae, Rhim Jung-Woo, Lee Kyung-Yil
Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Exp Pediatr. 2021 Jun;64(6):293-300. doi: 10.3345/cep.2020.00773. Epub 2020 Oct 14.
Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment.
This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children.
This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated.
A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03).
fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.
了解儿童发热性尿路感染（fUTI）的流行病学和患病率对于风险分层以及选择合适的尿液样本采集对象以辅助其诊断和治疗至关重要。
本研究旨在分析儿童首次fUTI的流行病学、病因及抗生素敏感性模式的变化。
这项回顾性观察队列研究纳入了2006 - 2016年期间被诊断并接受首次fUTI治疗的19岁以下儿童。分析电子病历并评估影像学图像。
共有359例患者（中位年龄5.1个月；四分位间距3.0 - 10.5个月）符合纳入标准；其中，78.0%（n = 280）年龄小于12个月。0 - 2个月的患者男女比例为5.3:1，3 - 5个月的患者为2.1:1，6 - 11个月的患者为1.6:1。12个月龄以后，女性占优势。大肠埃希菌是主要病因（83.8%），其次是肠球菌属（6.7%）和肺炎克雷伯菌（3.6%）。观察到多重耐药菌株比例（P < 0.001）和产超广谱β - 内酰胺酶（ESBL）菌株比例（P < 0.001）显著逐年增加。在膀胱输尿管反流（VUR）患者中，总体复发率为53.6%（n = 15）。当fUTI由产ESBL菌与非产ESBL菌引起时，观察到显著更高的复发率（75.0%对30.0%，P = 0.03）。
fUTI在12个月龄以下儿童中最为常见，12个月龄以上患者中女性占优势。引起fUTI的产ESBL菌比例正在增加。对于由产ESBL的肠道革兰氏阴性杆菌引起的fUTI，应考虑使用碳青霉烯类而非非碳青霉烯类药物治疗，以降低VUR儿童的短期复发率。
