Childhood Urinary Tract Infection: A Clinical Analysis of 597 Cases

我們針對本院九年來兒童時期泌尿道感染的病例做回溯性分析。從1995年1月至2003年12月我們一共收集了597例小於14歲因第一次泌尿道感染而住院的病童。其中男孩350例，女孩247例，男女比例爲1.42比1。年紀小於1歲有68.2%。值得注意的是有27.1%的病童在尿液鏡檢時，並無膿尿發現，相對的在尿液試紙反應也只有17.6%呈現nitrite陽性反應，明顯偏低，這在診斷泌尿道感染病童而言並不是一項可靠的指標。所有檢體一共分離出624株細菌，最多的是大腸桿菌(74.7%)，其次是變形桿菌(6.7%)及克列勃氏菌(6.4%)。大腸桿菌對ampicillin有82.0%及trimethoprim/sulfamethoxazole有55.2%的抗藥性發生。且值得重視的是，菌株的抗藥性有逐年增加的趨勢。此篇研究共有166例泌尿系統結構異常，其中最常見的是膀胱輸尿管逆流有87例(52.4%)。408例接受膀胱排尿攝影的病童中，有87例診斷爲膀胱輸尿管逆流(21.6%)。501例接受DMSA腎臟核子醫學掃描的病童中，有204例經掃描診斷為急性腎盂腎炎(40.7%)。我們的急性腎盂腎炎病童中，有33.2%證實有膀胱輸尿管逆流。相對的，DMSA腎臟核子醫學掃描為正常的病童中，只有9.7%有膀胱輸尿管逆流。DMSA腎臟核子醫學掃描是一項有意義的指標來預測膀胱輸尿管逆流的可能性。

關鍵字

泌尿道感染；兒童；抗生素抗藥性；泌尿道結構異常

並列摘要

Objectives of Study: To gain new insights into the epidemiology, genitourinary (GU) tract anomalies, etiologies, susceptibility of urinary pathogens to antibiotics in children with urinary tract infection (UTI) during the past decade in Taiwan. Materials and Methods: By reviewing medical charts for patients admitted to Kaohsiung Veterans General Hospital between January 1995 and December 2003, we identified and enrolled patients 14 years of age or less admitted due to UTI that was confirmed by positive urine culture. Results: A total of 597 patients made up our sample. Sixty-eight percent of patients were 1 year old or younger. Boys predominated infant cohort (68.1%). Twenty-seven point one percent of the patients were found in urinalysis to have 5 white blood cells or fewer per high power field and 17.6% had positive nitrite reaction. The pathogens were Escherichia coli, the most common (74.7%), followed by Proteus spp. (6.7%), and Klebsiella spp. (6.4%). E. coli was resistant to ampicillin in 82.0% of the cases, followed by sulfamethoxazoleltrimethoprim (55.2%), gentamicin (24.9%), and cefazolin (24%). Resistance to ampicillin and sulfamethoxazoleltrimethoprim tended to increase year by year. Forty point seven percent (164/408) of patients had GU tract anomalies, the most common being vesicoureteral reflux (VUR) (871164, 53.0%). Thirty-three point two percent of the patients with acute pyelonephritis, confirmed by (superscript 99m)Tc dimercaptosuccinic acid (DMSA) renal scan, had VUR. Conclusion: Our cohort was predominated by boys, especially in those less than a year old. E. coli, the most common pathogen, had a higher rate of resistance to ampicillin and sulfamethoxazolel trimethoprim. The pathogens that cause UTI were found to be becoming increasingly resistant to the common antimicrobial agents used in this study. The most common GU tract anomaly was VUR, yet the incidence was lower than that of other reports. A positive DMSA renal scan finding was a good indicator for prediction the possibility of VUR in UTI patients.

並列關鍵字

urinary tract infection ； children ； antibiotics resistance ； genitourinary tract anomaly

國際替代計量

Childhood Urinary Tract Infection: A Clinical Analysis of 597 Cases

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