Department of Pediatrics, Halland Hospital, Halmstad, Sweden.
Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Pediatr Nephrol. 2024 Nov;39(11):3251-3262. doi: 10.1007/s00467-024-06415-4. Epub 2024 Jul 15.
Urinary tract infection (UTI) in infants is a common, potentially life-threatening bacterial infection, and must be managed carefully through the entire chain of care from diagnosis, choice of treatment, follow-up and risk stratification of future complications. This Swedish nationwide study of infant UTI was conducted to evaluate the current management of infant UTI, yield of investigations and the Swedish UTI guidelines' ability to detect abnormalities of importance in the urinary tract.
Infants < 1 year with a first episode of UTI were included in a prospective multicenter study. Treatment and follow-up were provided by local pediatricians. Clinical and laboratory findings and imaging results were reported to the coordinating center. The current management and results were compared with a previous Swedish study.
One thousand three hundred six infants were included. Urine sampling was performed with clean catch technique in 93% of patients. Initial oral antibiotic treatment was used in 63%, predominantly third generation cephalosporines. Permanent kidney abnormalities were found in 10% and dilating vesicoureteral reflux (VUR) in 8%. Higher rates of male gender, non-E. coli infection and ultrasound dilatation were seen in infants < 1 month. UTI recurrences were reported in 18%.
Infant UTI is still generating a considerable amount of follow-up examinations. There is a significant shift towards clean catch as the main urine sampling method. Voiding cystourethrography is performed less frequently reducing the findings of low grade VUR. The incidence of renal scarring is comparable with earlier studies which suggests that the Swedish guidelines are able to identify individuals with risk for long-term complications.
婴儿尿路感染（UTI）是一种常见的、潜在威胁生命的细菌性感染，必须从诊断、治疗选择、随访和未来并发症风险分层等整个护理链进行仔细管理。这项瑞典全国性婴儿 UTI 研究旨在评估婴儿 UTI 的当前管理、检查结果的产生以及瑞典 UTI 指南在检测尿路重要异常方面的能力。
纳入首次发生 UTI 的年龄<1 岁的婴儿进行前瞻性多中心研究。治疗和随访由当地儿科医生提供。临床和实验室发现以及影像学结果报告给协调中心。当前的管理和结果与之前的瑞典研究进行了比较。
共纳入 1306 例婴儿。93%的患者采用清洁收集技术进行尿液采样。初始口服抗生素治疗应用于 63%的患者，主要为第三代头孢菌素。10%的患者发现永久性肾脏异常，8%的患者发现扩张性膀胱输尿管反流（VUR）。<1 个月的婴儿中，男性、非大肠埃希菌感染和超声扩张的比例较高。18%的患者报告 UTI 复发。
婴儿 UTI 仍需要进行大量随访检查。清洁收集作为主要尿液采样方法的比例显著增加。排尿性膀胱尿道造影的应用频率降低，从而减少低级别 VUR 的发现。肾瘢痕形成的发生率与早期研究相似，这表明瑞典指南能够识别有长期并发症风险的个体。
