兒童泌尿道感染

Urinary Tract Infection in Children

從西元1996年11月至2001年12月，在長達5年期間共收集338位年齡小於15歲兒罹患首次泌尿道感染(UTI)的病童，進行病歷的回溯性研究。包括：臨床表現，實驗檢查數據，腎臟超音波和腎臟核子醫學掃描等等。發燒為最常見之臨床表現 (84.9%)。尿液分析中顯示膿尿，亞硝鹽，蛋白尿，血尿之陽性反應分別為73.4%，33.6%，30.6%，和24.8%。從尿液分離出之菌種分析及對藥物之敏感試驗結果顯示Escherichia coli (E. Coli.)為兒童UTI最常見之致病菌 (72.5%)，依次為Proteus mirabilis (8.3%)，Enterococcus (5.6%)，和Klebsiella pneumoniae (4.7%)。第一線抗生素中以第一代Cephalosporin，如Cefazolin，對E. Coli之敏感性最高(86.5%)，依次為Gentamicin (78.0%)，Trimethoprim/Sulfamethoxazole (48.6%)，和Ampicillin (24.1%)。

A total of 338 children younger than 15 years old (222 boys and 116 girls) with a first episode of symptomatic urinary tract infection (UTI) from November 1996 to December 2001 were reviewed. The clinical presentations, laboratory data, and image studies were reviewed and analyzed. Two hundred-twenty seven (67.2%) of the 338 patients were younger than 1 year of age. The male to female ratio was 3.4:1 within the first 3 month of life, and was almost equal between 2 to 5 years old. Fever was the most common symptom of UTI (84.9%). Patients testing urinalysis positive for pyuria , nitrite , proteinuria , and hematuria account for 73.4%, 33.6%, 30.6% and 24.8%. Escherichia coli (E. coli) was the most common etiology (72.5%) of UTI, followed by Proteus mirabilis (8.3%), Enterococcus (5.6%), and Klebsiella pneumoniae (4.7%). E. coli was more sensitive to cefazolin (86.5%) than to gentamicin (78%), trimethoprim/sulfamethoxazole (48.6%), and ampicillin (24.1%). Fifteen patients developed concomitant bacteremia (5.3%). Risk factors for bacteremia in children with UTI included infants younger than one year old (86.7%), acute pyelonephritis (APN; 7 of 9 cases; 77.8%), and vesicoureteral reflux (VUR; 3 of 5 cases; 50%). Voiding cystourethogram (VCUG) was performed in 163 patients, and VUR was detected in 37 cases (22.7%). 99mTc dimercaptosuccinic acid (DMSA) renal scan was performed in 142 cases, and APN was found in 70 children (49.3%). The similar characteristics among UTI, VUR, APN, and bacteremia in this study were: 1) E. coli was the most common causative organism (72.5%; 81.1%; 90%; 93.3%, respectively); 2) Infants younger than one year old were the most common victims (67.2%; 83.3%; 82.9%; 86.7%, respectively). According to our analysis, there were statistically significant differences (P < 0.05) between APN patients (n= 70) and non-APN patients (n= 72) in following conditions : WBC count > 20000 /mm3, C-reactive protein value ≥ 5 mg/dl, highest body temperature ≥ 39.5。C, averaged day of defervescence after effective antibiotic therapy ≥ 4 days, proteinuria, a causative organism with E. coli, and positive finding in renal ultrasonography.