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Egyptian pediatric clinical practice guidelines for urinary tract infections in infants and children (evidence based)
Egyptian Pediatric Association Gazette ( IF 0.5 ) Pub Date : 2021-12-09 , DOI: 10.1186/s43054-021-00073-z
Bahia H. Moustafa 1 , Ahmed Badr 1, 2 , Moftah M. Rabie 3 , Ihab Z. El Hakim 4 , Ragia Marei Ali 4 , Moustafa El Balshy 5 , Nesreen Mohamad Kamal 6
Affiliation  

National evidence-based recommendations for diagnosis, treatment, imaging, and follow-up in urinary tract infection are crucial being a major health problem in pediatrics. Every region should follow international recommendations with respect to the disease local profile and available facilities for that area. Based on AGREE II (the assessment tool of practice guidelines), Egyptian CGLs used *American Academy Pediatrics, *European Association Urology, European Society Pediatric Urology, and *Asian Association Urinary tract infections as its evidence-based references. Health questions were listed for evidence base answers adopted from selected CGLs after their permission. Key statements were approved by all members and further approved by the Egyptian Pediatric Guidelines Committee after local and international external peer reviewing. (1) Diagnosis recommendations: Urine culture with diagnostic colony counts is essential for diagnosis. Catheter samples are important for critical cases and non-toilet-trained cases especially when they show significant bacteriuria and pyuria. (2) Treatment plan included areas of debate as choice of antibiotic, oral versus intravenous, duration, antibiotic prophylaxis considering age, disease severity, recurrence, + risk factors, and imaging reports. (3) Imaging recommendations were tailored to suit our community. Renal bladder ultrasound is important for children with febrile UTI, due to the high prevalence of congenital anomalies of the kidney and urinary tract, paucity of prenatal ultrasound, and lack of medical documentation to reflect previously diagnosed UTI or US reports. We recommend renal isotopic scan and voiding cystography for serious presentation, high-risk factors, recurrence, and abnormal US. (4) Urological consultation is recommended: in urosepsis or obstruction, male infants < 6 months. Acute basal DMSA is recommended in congenital renal hypodysplasia. Six months post-infection, US and DMSA are recommended in severe pyelonephritis and vesico-ureteric reflux, where those with abnormal US or DMSA or both should have voiding cystography. (5) Follow-up recommendations include family orientation with hazards of noncompliance and monitoring at pregnancy. Diagnosis and treatment show strong recommendations. Imaging depends on patient assessment. Referral to a pediatric nephrologist and urologist in complicated cases is crucial. Follow-up after the age of 16 years in adult clinics is important.

中文翻译:

埃及儿科婴儿和儿童尿路感染临床实践指南(循证)

尿路感染诊断、治疗、影像学和随访的国家循证建议对于儿科的主要健康问题至关重要。每个地区都应遵循有关疾病当地概况和该地区可用设施的国际建议。基于 AGREE II(实践指南的评估工具),埃及 CGL 使用 *American Academy Pediatrics、*European Association Urology、European Society Pediatric Urology 和 *Asian Association 泌尿道感染作为其循证参考。在获得许可后,从选定的 CGL 中采用的循证答案列出了健康问题。关键声明得到所有成员的批准,并在经过当地和国际外部同行审查后得到埃及儿科指南委员会的进一步批准。(1)诊断建议:尿培养与诊断性菌落计数对诊断至关重要。导管样本对于危重病例和未经如厕训练的病例很重要,尤其是当它们显示显着的菌尿和脓尿时。(2) 治疗计划包括争论的领域,如抗生素的选择、口服与静脉注射、持续时间、考虑年龄、疾病严重程度、复发、+危险因素和影像学报告的抗生素预防。(3) 影像推荐是根据我们的社区量身定制的。肾膀胱超声对于发热性 UTI 儿童很重要,因为肾脏和泌尿道先天性异常的高发率、产前超声的缺乏以及缺乏反映先前诊断出的 UTI 或美国报告的医疗文件。对于严重的表现、高危因素、复发和超声异常,我们建议进行肾同位素扫描和排尿性膀胱造影。(4)建议泌尿外科会诊:尿脓毒症或梗阻,<6个月的男婴。先天性肾发育不良推荐使用急性基础 DMSA。感染后 6 个月,推荐 US 和 DMSA 用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。高危因素、复发和异常US。(4)建议泌尿外科会诊:尿脓毒症或梗阻,<6个月的男婴。先天性肾发育不良推荐使用急性基础 DMSA。感染后 6 个月,推荐 US 和 DMSA 用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。高危因素、复发和异常US。(4)建议泌尿外科会诊:尿脓毒症或梗阻,<6个月的男婴。先天性肾发育不良推荐使用急性基础 DMSA。感染后 6 个月,推荐 US 和 DMSA 用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。在尿脓毒症或梗阻中,男婴 < 6 个月。先天性肾发育不良推荐使用急性基础 DMSA。感染后 6 个月,推荐 US 和 DMSA 用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。在尿脓毒症或梗阻中,男婴 < 6 个月。先天性肾发育不良推荐使用急性基础 DMSA。感染后 6 个月,推荐 US 和 DMSA 用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。US 和 DMSA 推荐用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿性膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。US 和 DMSA 推荐用于严重肾盂肾炎和膀胱输尿管反流,其中 US 或 DMSA 或两者异常的患者应进行排尿性膀胱造影。(5) 后续建议包括不依从危害的家庭导向和妊娠监测。诊断和治疗显示出强烈的建议。成像取决于患者的评估。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。在复杂病例中转诊至儿科肾病学家和泌尿科医生至关重要。成人诊所 16 岁后的随访很重要。
更新日期:2021-12-09
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