Lindén Magnus, Rosenblad Therese, Hansson Sverker, Brandström Per
Department of Paediatrics, Halland Hospital, Halmstad, Sweden.
Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta Paediatr. 2025 Jun;114(6):1229-1237. doi: 10.1111/apa.17554. Epub 2024 Dec 18.
To audit adherence to the Swedish paediatric guidelines for urinary tract infections (UTIs) in infants. Secondary objectives were to compare findings on imaging performed according to the guidelines with imaging without guideline support and to identify predictors of non-adherence.
A prospective multicentre study of infants <1 year treated at paediatric hospitals for their first UTI. Adherence to recommendations was assessed for diagnosis, treatment, and imaging of the urinary tract with a follow-up period of 1 year. Vesicoureteral reflux on voiding cystourethrography and findings on renal scintigraphy according to recommendations were compared to imaging without recommendation.
A total of 1357 infants were included. Adherence to recommended diagnostic procedures, antibiotic treatment, and imaging was 86.1%, 91.0% and 64.2%, respectively. Non-adherence to imaging recommendations was associated with inpatient management and smaller hospitals but was also more often due to excessive rather than refrained imaging.
High adherence rates to diagnostic and treatment recommendations indicate careful attention to infant UTI among paediatricians. Lower adherence to imaging recommendations raises concerns regarding the guideline algorithm; particularly, early DMSA scans seem to be challenging for smaller hospitals.
审核瑞典婴幼儿尿路感染（UTI）儿科指南的遵循情况。次要目标是比较按照指南进行的影像学检查结果与无指南支持的影像学检查结果，并确定不遵循指南的预测因素。
一项针对在儿科医院接受首次UTI治疗的1岁以下婴儿的前瞻性多中心研究。对尿路诊断、治疗和影像学检查的推荐遵循情况进行评估，随访期为1年。将排尿性膀胱尿道造影的膀胱输尿管反流情况及根据推荐进行的肾闪烁显像结果与无推荐的影像学检查结果进行比较。
共纳入1357名婴儿。对推荐的诊断程序、抗生素治疗和影像学检查的遵循率分别为86.1%、91.0%和64.2%。不遵循影像学检查推荐与住院治疗管理及规模较小的医院有关，但更多是由于过度检查而非检查不足。
对诊断和治疗推荐的高遵循率表明儿科医生对婴幼儿UTI给予了密切关注。对影像学检查推荐的较低遵循率引发了对指南算法的担忧；特别是，早期二巯基丁二酸（DMSA）扫描对较小的医院来说似乎具有挑战性。
