在患有III级,IV级或V级膀肠道逆流症的婴儿中进行抗生素预防
William Morello1, Esra Baskin1, Augustina Jankauskiene1
1From the Pediatric Nephrology, Dialysis, and Transplant Unit (W.M., G.P., J.S., G.M.) and the Pediatric Urology Unit (D.G.M.), Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, and the Department of Clinical Sciences and Community Health, University of Milan (G.M.), Milan, the Department of General and Specialized Surgery for Women and Children, Università degli Studi della Campania "Luigi Vanvitelli," Naples (A.L.M., S.G., P.M.), the Institute for Maternal and Child Health-IRCCS Burlo Garofolo (M.P., E. Barbi) and the Department of Medical, Surgical, and Health Sciences, University of Trieste (E. Barbi), Trieste, Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (C.L.S., A.P.), the Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence (F.B., M.M.), Pediatria C, Ospedale Donna Bambino, Verona (M.B.), the Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria Gaetano Martino, University of Messina, Messina (R.C.), the Nuclear Medicine Unit, Circolo Hospital and Macchi Foundation, Azienda Socio Sanitaria Territoriale Sette Laghi, Varese (D.D.P.), the Nuclear Medicine Unit, Department of Medicine, University Hospital of Padua (P.Z.), and the Pediatric Nephrology, Dialysis, and Transplantation Unit, Department of Women's and Children's Health, University of Padua (I.A.), Padua - all in Italy; the Department of Pediatric Nephrology, Başkent University Faculty of Medicine (E. Baskin, K.G.), and the Department of Pediatric Nephrology, Ankara University School of Medicine (F.Y., Z.B.O.), Ankara, the Department of Pediatric Nephrology and Pediatric Rheumatology, Pamukkale University School of Medicine, Denizli (S.Y.), and the Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul (S.C.) - all in Turkey; the Pediatric Center, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius (A.J., D.R.), and the Department of Radiology, Medical Academy, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas (D.V.) - both in Lithuania; the Department of Pediatrics, Nephrology, and Hypertension, Medical University of Gdansk, Gdansk (A.Z., A.K.), the Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw (G.K., A.S.), the Department of Pediatric Nephrology and Hypertension, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Krakow (D.D.), the Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice (M.S.), the Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok (K.T.-J.), and the Department of Pediatrics, Immunology, and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz (M.T.) - all in Poland; the Department of Pediatric Nephrology, University Hospitals Leuven (D.M., S.D.R.), and PKD Research Group, Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven (D.M.), Leuven, and the Division of Nephrology, Department of Pediatrics, University Hospital Center of Liège, Liège (J.L.) - all in Belgium; the Department of Pediatric Nephrology, University Hospital Vall d'Hebron, and Universidad Autónoma de Barcelona, Hospital Vall d'Hebron (G.A.), and Pediatric Nephrology, Hospital General de Granollers, Universitat Internacional de Catalunya (M.C.), Barcelona, and Hospital General Universitario Santa Lucía, Cartagena (J.E.C.S.) - all in Spain; the University of Cologne, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, Cologne (L.T.W.), and the Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg (O.M., F.S.) - both in Germany; and the Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal (A.C.A.).
持续的抗生素预防可显著降低患有严重膀回流的婴儿的第一个尿路感染 (UTI). 然而,它也增加了抗生素耐药性和非大肠杆菌感染.
科学领域:
- 儿科脏病学 儿科脏病学
- 传染性疾病 传染性疾病
- 临床试验 临床试验
背景情况:
- 持续抗生素预防预防在患有高度膀回流 (VUR) 的婴儿中预防尿路感染 (UTIs) 的有效性仍在争论中.
- 患有III,IV或VVUR等级的婴儿有复发性尿路感染和潜在的损伤的风险.
研究的目的:
- 评估持续抗生素预防在预防III-V级VUR的婴儿第一次尿路感染的有效性.
- 评估二次结果,包括新的脏痕和功能 (GFR).
主要方法:
- 一个随机的,开放的试验,涉及292名婴儿 (1-5个月大),患有III级-V级VUR,没有先前的尿路感染.
- 参与者被分配接受持续的抗生素预防或24个月不接受治疗.
- 主要结局:第一个尿路感染的发生;次要结局:脏痕和GFR在24个月.
主要成果:
- 第一次尿路感染发生在预防组的21.2%,而未接受治疗组的35.6% (HR 0.55;P=0.008).
- 两组之间没有观察到新的脏痕或估计的GFR的显著差异.
- 在预防组中注意到非大肠杆菌生物和抗生素耐药性的增加.
结论:
- 持续的抗生素预防在预防高度VUR.UR的婴儿最初的尿路感染方面提供了显著的,尽管很小的好处.
- 预防策略导致抗生素耐药性和非大肠杆菌病原体的患病率增加.
- 在为这一群体开处方预防时,需要仔细考虑风险和益处.
相关概念视频
Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
Urinary Tract Infection IV: Nursing Management
Acute Pyelonephritis II: Diagnostic Studies and Management
Imaging Studies V: Intravenous Urography and Retrograde Pyelography
Acute Pyelonephritis I: Introduction
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