儿童泌尿系感染的诊断和治疗  

Diagnosis and treatment of urinary tract infections in children

作　　者：高春林 GAO Chun-lin(Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Jinling School of Clinical Medicine,Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院、南京医科大学金陵临床医学院、东部战区总医院儿科,江苏南京210002

出　　处：《中国实用儿科杂志》2025年第1期13-20,共8页Chinese Journal of Practical Pediatrics

基　　金：南京大学医学院附属金陵医院(东部战区总医院)临床研究专项续航项目(22LCYYXH9)。

摘　　要：泌尿系感染即尿路感染(UTI)是儿童常见感染性疾病,是指有尿路感染症状并且尿液培养中见单一种类的细菌显著生长,其中最常见的病原体是革兰阴肠道细菌(大肠杆菌占80%以上),UTI包括上尿路感染(肾盂肾炎)、下尿路感染(膀胱及尿道炎)、无症状菌尿,临床表现与年龄相关,<2岁的婴幼儿不典型,可以为不明原因发热,查体和病史询问需要注意排查有无复杂性UTI的危险因素,尿液分析和合适尿标本培养发现单一细菌大量生长可确诊,初发的UTI需要行肾脏和膀胱超声检查,反复发作的UTI进一步行影像学检查排除膀胱输尿管反流(VUR)和瘢痕肾,治疗以口服抗生素治疗为主,下尿路感染可短疗程3~5 d,上尿路感染行敏感抗生素7~14 d的先静脉后口服序贯治疗,同时治疗潜在的膀胱肠道功能障碍和下尿路功能异常非常重要,由于高级别的VUR是UTI和肾瘢痕形成的危险因素,需要长期抗生素预防。Urinary tract infection(UTI)is one of common infectious diseases in children,which refers to the disease with symptoms of urinary tract infection and significant growth of a single type of bacteria in urine culture,and the most common pathogen is Gram's negative intestinal bacteria(E.coli accounts for more than 80%).UTI includes upper urinary tract infection(pyelonephritis),lower urinary tract infection(cystitis and urethritis)and asymptomatic bacteriuria.The clinical manifestations are age-related,and in infants less than 2 years old,they are not typical and it may be unexplained fever.In physical examination and medical history inquiry,attention should be paid to whether there are risk factors for complicated UTI.The diagnosis can be confirmed if there is significant growth of single bacteria in urine analysis and suitable urine specimen culture.For primary UTI,ultrasonic examination of kidney and bladder is necessary.For recurrent UTI,further imaging examinations should be performed to rule out vesicoureteral reflux(VUR)and CAKUT,and oral antibiotics should be the main treatment.A short course of 3-5 days’treatment is needed for lower urinary tract infection and a sequential course of treatment is needed for upper urinary tract infection with 7-14 days of intravenoussensitive antibiotics followed by oral treatment.At the same time,it is very important to treat potential vesico-intestinal dysfunction and lower urinary tract dysfunction.Since high-grade VUR is a risk factor for UTI and renal scarring,long-term antibiotic prophylaxis is required.

关 键 词：尿路感染 儿童 膀胱输尿管反流 

分 类 号：R72[医药卫生—儿科]