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題 名 | Urinary Tract Infection in Children=兒童期泌尿道感染 |
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作 者 | 顏志瑋; 陳德輝; | 書刊名 | 微免與感染雜誌 |
卷 期 | 32:3 1999.09[民88.09] |
頁 次 | 頁199-205 |
分類號 | 417.575 |
關鍵詞 | 泌尿道感染; 阷[fef5]Tc-dimercaptosuccinic acid renal scan; Urinary tract infection; Vesicoureteric reflux; |
語 文 | 英文(English) |
中文摘要 | 我們針對本院兒童期泌尿道感染作三年的回溯性分析。從1995年7月至1998年6月 我們一共收集了 285 例小於 15 歲因泌尿道感染而住院的病童。 其中男孩 169 例, 女孩 116 例,男女比約為 1.46 比 1。平均年齡為 18.6 個月,絕大多數小於 2 歲。 臨床上最 常見到的症狀為發燒, 97.7 %小於 2 歲的病童有發燒,但也有超過一半大於 2 歲的病童 並沒有發燒而以嘔吐、頻尿或腹痛等症狀來表現。 值得注意的是:16.8 %的病童在尿液鏡 檢時並無膿尿發現,也有 13.4 %的病童在鏡檢時找不到細菌。 尿液試紙反應 nitrite 陽 性率 34.7 %,明顯偏低,對篩選泌尿道感染病童而言並不可靠。從所有檢體中一共分離出 292 株細菌,最多的是大腸桿菌( 80.5 %),其次是克列勃氏菌( 7.5 %)。 大腸桿菌 對 ampicillin 有高達 90.2 %的抗藥性, 對 trimethoprim ╱ sulfamethoxazole 也有 57.1 %的抗藥性。187 位病童接受膀胱輸尿管逆流攝影,46 位( 24.6 %)證實有膀胱輸 尿管逆流。而在 98 位接受 DMSA 腎臟核子醫學掃瞄檢查的病童中,有 62 位( 63.3 %) 經掃瞄診斷為急性腎盂腎炎。經由腎臟超音波來預測病童是否可能有膀胱輸尿管逆流或腎盂 腎炎的陽性預測率,分別為 30.7 %及 78.9 %。膀胱輸尿管逆流以往經常被認為是造成急 性腎盂腎炎的主因,但我們的急性腎盂腎炎病童中,僅 37 %證實有膀胱輸尿管逆流,這和 近年來國外一些研究報告結果相近。我們也試著從臨床症狀及一些急性炎病指標去分析膀胱 輸尿管逆流或腎盂腎炎的危險因子,發現逆流性病變的病童和急性腎盂腎炎的病童皆有明顯 較長的發燒天數;而較高的 C-reactive protein 值則顯示病童有急性腎盂腎炎可能性較高 。 |
英文摘要 | Two hundred and eighty-five children under 15 years old (169 boys and 116 girls) who had urinary tract infection (UTI) were admitted to our hospital during the period July 1995 to June 1998. Clinical presentation, laboratory data and image studies were recognized and analyzed. Most patients were younger than 2 years of age. Fever is the most common sign, especially in young children. With the urinary dipstick test a low positive rate of nitrite reaction (34.7%) was found. E. coli is the most common pathogen and exclusively resistant to ampicillin (90.2%) . The E. coli is also relatively resistant to trimethoprim/sulfamethoxazole (57.1%). Voiding cystourethrogram was performed in 187 cases, in which 24.6% of those patients showed vesicoureteric reflux. Ninety-eight children received �� Tc-dimercaptosuccinic acid renal scans and 62 cases (63.3%) had abnormal findings compatible with pyelonephritis. The positive predictive values by renal ultrasonography for vesicoureteric reflux and pyelonephritis are 3.07% and 78.9%, respectively. In pyelonephritis patients, only 37% also had a vesicoureteric reflux. The fever duration and clinical inflammatory parameters were evaluated in all patients. Longer febrile periods are the risk of vesicoureteric reflux and pyelonephritis, and a high C-reactive protein concentration indicates the risk of pyelonephritis. In conclusion, fever was the most common sign in young UTI children who had a low positive nitrite reaction rate in the dipstick test. E. coli was the most common pathogen with a high ampicillin resistance in Taiwan. Only 37% pyelonephritis patients had refluxing nephropathy. It is indicated that pyelonephritis is not always attributed to reflux of infected urine. A longer febrile period and a high C-reactive protein level are good indicators for prediction of the risk of pyelonephritis in UTI patients. |
本系統中英文摘要資訊取自各篇刊載內容。