Hari Pankaj, Meena Jitendra, Kumar Manish, Sinha Aditi, Thergaonkar Ranjeet W, Iyengar Arpana, Khandelwal Priyanka, Ekambaram Sudha, Pais Priya, Sharma Jyoti, Kanitkar Madhuri, Bagga Arvind
Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India.
Pediatr Nephrol. 2024 May;39(5):1639-1668. doi: 10.1007/s00467-023-06173-9. Epub 2023 Oct 28.
We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 10 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
我们展示了印度儿科学会（ISPN）针对儿童尿路感染（UTI）和原发性膀胱输尿管反流（VUR）管理的最新循证临床实践指南。这些指南符合国际标准；使用了医学研究所和AGREE清单来确保指南制定过程的透明度、严谨性和全面性。鉴于其稳健的方法学，这些指南在全球范围内适用于UTI和VUR的管理。已制定了17项建议和18个临床实践要点。一些关键建议和实践要点如下。如果临床怀疑强烈，对于婴儿UTI的诊断，尿培养菌落形成单位>10/mL被认为具有诊断意义。尿白细胞酯酶和亚硝酸盐可作为疑似UTI儿童尿液显微镜检查的替代筛查试验。非中毒性婴儿的急性肾盂肾炎可用口服抗生素治疗7 - 10天。不建议在UTI评估中进行急性期二巯基丁二酸（DMSA）扫描。排尿性膀胱尿道造影（MCU）适用于复发性UTI、肾脏超声异常的儿童，以及2岁以下非大肠杆菌UTI的患者。二巯基丁二酸扫描（DMSA扫描）仅适用于复发性UTI和高级别（3 - 5级）VUR的儿童。UTI后尿路正常的儿童不建议使用抗生素预防。建议对膀胱肠道功能障碍（BBD）儿童和高级别VUR儿童进行预防以防止UTI。对于VUR儿童，如果已接受如厕训练、无BBD且过去1年未发生UTI，则应停止预防。对于高级别VUR，若家长更倾向于手术干预而非抗生素预防，或儿童在接受抗生素预防时仍反复出现突破性发热性UTI，可考虑手术干预。
