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子どもにおける尿路感染症の再発:リスク要因と,予防的抗微生物薬との関連
Patrick H Conway1, Avital Cnaan, Theoklis Zaoutis
1Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA. pconway2@mail.med.upenn.edu
JAMA
|July 12, 2007
まとめ
抗微生物予防は,小児における尿路感染症 (UTI) の再発を減少させなかった. しかし,再発性尿路感染症では抗生物質耐性のリスクを高め,小児のケアに対する重大な懸念を強調しました.
科学分野:
- 小児感染症は,小児の感染症です.
- 臨床流行病学 臨床流行病学とは
- 抗菌薬の管理について
背景:
- 尿路感染症 (UTI) の危険因子と,小児における抗菌剤予防の有効性に関する証拠は限られている.
- 再発性尿路感染症は,小児初等医療における大きな課題となっています.
研究 の 目的:
- 6歳以下児における再発性尿路感染症のリスク要因を特定する.
- 抗微生物予防と再発性尿路感染症との関連を判断する.
- 再発性尿路感染症における抗菌剤耐性の危険因子を特定する.
主な方法:
- 27の小児診療所から最初のUTIを患った611人の子供に関するコホート研究.
- 危険因子と予防との関連を評価するために,イベントまでの時間分析.
- レジスタンスのリスク要因を特定するための内蔵症例対照研究.
主要な成果:
- 白人人種,年齢3~5歳,およびグレード4~5の膀回流症は,再発性尿路感染症のリスクの増加と関連していました.
- 抗微生物予防は,再発性尿路感染症のリスクの低下と有意な関連性を示さなかった.
- 抗菌剤予防は,再発性尿路感染症における抗菌剤耐性の重要なリスク因子でした.
結論:
- 抗微生物予防は,小児における再発性尿路感染症のリスクの低下と関連していません.
- 予防使用は,小児性尿路感染症において,耐性感染症を発症するリスクの増加と関連しています.
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