Department 2 of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
School of Pediatrics, Capital Medical University, Beijing, China.
BMJ Open. 2022 Apr 27;12(4):e057736. doi: 10.1136/bmjopen-2021-057736.
To explore the current Chinese and English guidelines of urinary tract infection (UTI) in children and provide a summary of the recommendations of the guidelines.
An electronic search was conducted on databases, including Pubmed, SinoMed, Wangfang Data, CHKD,VIP, NICE, WHO, GIN and Medliveto retrieve data of the clinical practice guidelines on UTI from the establishment of the database to June 2020. Four assessors assessed the quality of guidelines using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and evaluated the specific recommendations in guidelines.
(1) Nine guidelines including two from the USA (AAP and A guideline for the inpatient care of children with pyelonephritis) and the remaining from EAU/ESPU, SINEPE, KHA-CARI, CPS, ISPN, NICE and CMA-CSP were explored. (2) The AGREE II evaluation demonstrated higher scores of UTI guidelines in terms of 'scope and purpose' (72.99%±11.19%) and 'clarity of presentation' (75.62%±7.75%), whereas the average scores were lower in the aspect of 'stakeholder involvement' (35.49%±14.41%), 'rigour of development' (37.05%±10.05%), 'applicability' (37.75%±11.98%) and 'editorial independence' (43.06%±48.14%). The average scores of the guidelines were as follows: SINePe (72.57%), CMA-CSP (62.96%), EAU/ESPU (59.61%), AAP (56.86%), NICE (47.54%), CPS (40.93%), KHA-CARI (38.86%), ISPN (38.63%) and A guideline for the inpatient care of children with pyelonephritis (34.72%). (3) All the selected guidelines basically reached a consensus on urine sample retention methods in older children, the antibiotic treatment course and renal and bladder ultrasonography application but lacked a conclusion on the determination of urine culture results, the choice of voiding cystourethrography and Tc-99mdimercaptosuccinicacid, and antibiotic prophylaxis.
There remains a need to improve the quality of guidelinesfor UTI in clinical practice. Existing controversies on the current guidelines of UTI in some recommendations warrant further exploration to provide more evidence on formulating more unified and practical guidelines in the future.
No ethical approval is required for this research, as it did not include patients or patient data.
探讨当前中、英文儿童尿路感染（UTI）指南，并总结指南推荐意见。
计算机检索 Pubmed、SinoMed、万方数据、CHKD、VIP、NICE、WHO、GIN、Medliveto 等数据库，自建库起至 2020 年 6 月，检索关于儿童 UTI 的临床实践指南，由 4 位评价员按照 AGREE II 工具评价指南质量，并对指南推荐意见进行具体评价。
（1）共纳入指南 9 部，其中美国儿科学会（AAP）和欧洲泌尿外科学会/欧洲小儿尿外科学会（EAU/ESPU）各有 1 部指南，其余 7 部分别来自西班牙儿科肾脏病学会（SINEPe）、加拿大儿科协会（CPS）、中华医学会儿科学分会肾脏学组（ISPN）、英国国家卫生与临床优化研究所（NICE）、中国妇幼保健协会（CMA-CSP）、中国医师协会儿科医师分会肾脏专家委员会（KHA-CARI），内容涉及儿童 UTI 的诊疗和预防。（2）AGREE II 评价结果显示，UTI 指南在“范围和目的”“表述的清晰性”方面得分较高（72.99%±11.19%、75.62%±7.75%），而在“利益相关者的参与”“制定的严谨性”“适用性”和“编辑独立性”方面得分较低（35.49%±14.41%、37.05%±10.05%、37.75%±11.98%、43.06%±48.14%）。指南平均得分从高到低依次为：SINEPe（72.57%）、CMA-CSP（62.96%）、EAU/ESPU（59.61%）、AAP（56.86%）、NICE（47.54%）、CPS（40.93%）、KHA-CARI（38.86%）、ISPN（38.63%）、A guideline for the inpatient care of children with pyelonephritis（34.72%）。（3）各指南基本达成共识，推荐大龄儿童中段尿标本留取方法、抗生素治疗疗程、泌尿系超声检查应用，但对尿培养结果判读、排尿性膀胱尿道造影和 Tc-99mdimercaptosuccinicacid 选择、抗生素预防应用等推荐意见仍存在争议。
儿童 UTI 临床实践指南质量有待提高，部分推荐意见仍存在争议，需要进一步研究，为未来制定更加统一、实用的指南提供更多证据。
本研究无需伦理审批，因为它不涉及患者或患者数据。
译文仅供参考，建议以英文原文为准。
