一种风险分层模型,用于预测在已知的膀回流症儿童中停止持续抗生素预防后发烧性尿路感染的风险
Suhaib Abdulfattah1, Nicole J Kye1, Avi P Shah1
1Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The Journal of urology
|October 10, 2025
概括
许多患有持续性膀外流 (VUR) 的儿童在所训练后可以安全地停止抗生素预防. 肠道和膀功能障碍和高度VUR是发烧性尿路感染 (fUTI) 风险的关键预测因素.
科学领域:
- 儿科脏病学 儿科脏病学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 传染性疾病 传染性疾病
背景情况:
- 持续的抗生素预防 (CAP) 是对患有持续性初级膀外流 (VUR) 的儿童的标准.
- 在所训练后,经常考虑停止CAP,但需要预测发烧性尿路感染 (fUTI) 风险.
- 在CAP停止之前,并非总能获得VUR解决方案的放射性确认.
研究的目的:
- 评估持续性初级VUR儿童中fUTI的临床特征和预测因素,这些儿童在没有放射性确认解决方案的情况下停止了CAP.
- 为了确定CAP在所训练后是否可以安全地停止使用.
- 开发一个名图,用于预测 CAP 停止后的 FUTI 风险.
主要方法:
- 对386名患有初级VUR的儿童进行了回顾性审查,这些儿童停止了CAP.
- 多变量考克斯比例危险建模以确定fUTI预测因素.
- 构建和验证预测性名图和简化临床风险评分.
主要成果:
- 在386名儿童中,41人 (11%) 在CAP停药后出现了fUTI.
- 肠道和膀功能障碍 (HR=16.1) 和高度VUR (HR=2.31) 是fUTI的独立风险因素.
- 诺米图表显示出良好的预测性表现 (C指数=0.77),风险评分将患者分为低,中和高风险组.
结论:
- 停止CAP治疗对于某些患有持续VUR的儿童,特别是那些没有空白功能障碍的儿童,是一种可行的策略.
- 一个预测性名录图有助于个人为CAP停产做出决定.
- 需要进一步的前性研究来完善风险分层和管理策略.
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