Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; General Pediatrics Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency, Hôpital Robert Debré, Paris, France.
Infect Dis Now. 2023 Nov;53(8S):104786. doi: 10.1016/j.idnow.2023.104786. Epub 2023 Sep 18.
Urinary tract infections are the most frequently proven bacterial infections in pediatrics. The treatment options proposed in this guide are based on recommendations published by the Groupe de Pathologie Infectieuse de Pédiatrique (GPIP-SFP). Except in rare situations (newborns, neutropenia, sepsis), a positive urine dipstick for leukocytes and/or nitrites should precede a urine culture examination and any antibiotic therapy. After rising steadily between 2000 and 2012, the proportion of Escherichia coli strains resistant to extended-spectrum ß-lactamases (E-ESBL) has remained stable over the last ten years (between 7% and 10% in pediatrics). However, in many cases no oral antibiotic is active on E-ESBL leading either to prolonged parenteral treatment, or to use of a non-orthodox combination such as cefixime + clavulanate. With the aim of avoiding penem antibiotics and encouraging outpatient management, this guide favors initial treatment of febrile urinary tract infections (suspected or actual E-ESBL infection), with amikacin. Amikacin remains active against the majority of E-ESBL strains. It could be prescribed as monotherapy for patients in pediatric emergency departments or otherwise hospitalized patients.
尿路感染是儿科最常见的细菌性感染。本指南中提出的治疗方案是基于儿科感染病理学组（GPIP-SFP）发布的建议。除了在罕见情况下（新生儿、中性粒细胞减少症、败血症），白细胞和/或亚硝酸盐尿干化学检测阳性应先于尿培养检查和任何抗生素治疗。在 2000 年至 2012 年期间稳步上升之后，过去十年中，对扩展谱β-内酰胺酶（E-ESBL）具有耐药性的大肠杆菌菌株的比例一直保持稳定（儿科为 7%至 10%）。然而，在许多情况下，没有一种口服抗生素对 E-ESBL 有效，这要么导致长期的肠外治疗，要么导致使用非传统的联合治疗，如头孢克肟+克拉维酸。为了避免使用碳青霉烯类抗生素并鼓励门诊管理，本指南主张对发热性尿路感染（疑似或实际的 E-ESBL 感染）进行初始治疗，使用阿米卡星。阿米卡星对大多数 E-ESBL 菌株仍具有活性。对于儿科急诊部门或其他住院患者，可以将其作为单一疗法进行处方。
