Review Article
Febrile Urinary Tract Infections in Children
Giovanni Montini, M.D., Kjell Tullus, M.D., Ph.D., and Ian Hewitt, M.B., B.S.
N Engl J Med 2011; 365:239-250July 21, 2011
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Цитата:
Acute pyelonephritis is the most common serious bacterial infection in childhood; many affected children, particularly infants, have severe symptoms. Most cases are readily treated, provided diagnosis is prompt, though in some children fever may take several days to abate.
Approximately 7 to 8% of girls and 2% of boys have a urinary tract infection during the first 8 years of life.1,2 Febrile urinary tract infections have the highest incidence during the first year of life in both sexes, whereas nonfebrile urinary tract infections occur predominantly in girls older than 3 years.2 After infancy, urinary tract infections confined to the bladder are generally accompanied by localized symptoms and are easily treated. In contrast, the presence of fever increases the probability of kidney involvement (sensitivity, 53 to 84%; specificity, 44 to 92%)3 and is associated with an increased likelihood of underlying nephrourologic abnormalities and a greater risk of consequent renal scarring.4 ...
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Цитата:
Conclusions
The management of febrile urinary tract infections in children is changing. Oral and intravenous antibiotics appear to be equally effective in most children. Improved prenatal ultrasonography has revealed that major kidney damage in children is frequently related to the presence of hypodysplasia, associated with urologic abnormalities. However, infection-related renal scarring develops in some children; this causes further damage in dysplastic kidneys, with the potential for late effects in previously normal kidneys. The value of antibiotic prophylaxis has been questioned in recent studies (Figure 4). Further data are needed to determine which children might benefit from antibiotic prophylaxis. Studies in progress may help to answer these questions.
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