儿童难治性尿路感染诊断与治疗策略

Diagnosis and treatment strategy in children with refractory urinary tract infection

儿童难治性尿路感染(UTI)是临床棘手问题,主要包括:复杂性UTI,慢性肾脏病并UTI,导管相关性UTI,代谢性疾病,治疗不规范等医源性因素导致的超广谱耐药菌、L型细菌、其他特殊病原菌感染所致的UTI,以及免疫力低下患者的UTI。本文讨论了难治性UTI的诊断治疗策略,重点讨论抗生素治疗原则、膀胱输尿管反流的治疗方法及改善患者免疫状态等。通过采取综合治疗策略,对可以手术纠正的复杂原因(如膀胱输尿管反流、梗阻等)必要时行手术治疗,有助于提高难治性UTI的疗效,减少复发率,保护肾小管功能,延缓肾间质病变进展。

Children＇s refractory urinary tract infection （UTI） is a tough clinical problem, including complicated UTI, chronic kidney disease with UIT, catheter associated UTI, UTI in patients with immunologic inadequacy and UTIs caused by extend spectrum drug-resistance bacteria, L-form bacteria or other special pathogenic bacteria, which are mostly induced by metabolic diseases and improper iatrogenic factors. This article discusses the diagnosis and treatment in children with refractory UTIs, especially the principles of antibiotic therapy, management of vesicoureteral reflux （VUR） as well as improvement of patients＇ immune state. Surgical intervention is essential when some complicated etio- logical factors such as VUR or obstruction are detected. Multi-modality therapeutic strategy has great significance in im- proving the effect of refractory UTIs, decreasing the recurrence rate, protecting tubular function and retarding progres- sion of renal interstitial diseases.