Liu Xin,Liu Ge,Yang Yi.Related factors predicting breakthrough febrile urinary tract infection in children with vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(10):911-916.[doi:10.3760/cma.j.cn101785-202307033-003]
儿童原发性膀胱输尿管反流突破性尿路感染的风险因素分析
- Title:
- Related factors predicting breakthrough febrile urinary tract infection in children with vesicoureteral reflux
- Keywords:
- Vesico-Ureteral Reflux; Urinary Tract Infection; Risk Factors; Child
- 摘要:
- 目的 总结分析儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)发生突破性发热性尿路感染(urinary tract infection,UTI)的相关因素。方法 回顾性分析2018年1月至2022年11月中国医科大学附属盛京医院经排泄性膀胱尿道造影诊断的儿童原发性膀胱输尿管反流患儿临床资料,总结其临床特点,并对其进行电话随访,收集患儿临床资料及影像学资料,将随访过程中发生突破性发热性UTI的患儿作为研究组,未发生突破性发热性UTI的患儿作为对照组,进行单因素及多因素Logistic回归分析。结果 共140例膀胱输尿管反流患儿纳入本研究,其中女童62例,男童78例;首次发生UTI的中位年龄为4个月;双侧膀胱输尿管反流76例,单侧膀胱输尿管反流64例;高级别膀胱输尿管反流65例(65/140,46.4%);存在膀胱直肠功能障碍50例(50/140,35.7%); 其中68例(68/140,48.6%) 至少经历1次突破性发热性UTI,72例(72/140,51.4%)在诊断VUR后口服预防剂量抗生素期间无UTI。单因素分析结果显示,是否为高级别VUR、输尿管远端直径比(ureteral diameter ratio,UDR)及是否存在膀胱直肠功能障碍(bladder-bowel dysfunction,BBD)与突破性发热性UTI相关;Logistic回归分析结果显示,是否高级别VUR(OR=2.942,95%CI:1.219~7.099,P=0.016)、UDR(OR=1 313.746,95%CI:35.720~48 318.362,P＜0.001)是VUR发生突破性发热性UTI的相关因素。结论 高级别膀胱输尿管反流和输尿管远端直径比大于0.330是膀胱输尿管反流患儿发生突破性发热性UTI的相关因素,临床应积极治疗,严密监控,防止发生肾功能损伤。
- Abstract:
- Objective To evaluate the feasibility of individual patient-related related factors as the predictive factors for breakthrough febrile urinary tract infection (UTI) in children with vesicoureteral reflux (VUR).Methods For this retrospective study,140 children with primary VUR and detailed data of voiding cystourethrogram (VCUG) were identified from 2018 to 2022.There were 78 boys and 62 girls with a median age of 4 months at initial febrile UTI.Clinical characteristics were collected for identifying the predictors of breakthrough febrile UTI.Univariate and multivariable analyses were performed.Statistical analysis was performed with SPSS version 21.0 software package.Results VUR was bilateral (n=76) and unilateral (n=64).There were advanced VUR (n=65,46.4%) and bladder-bowel dysfunction (n=50,35.7%).And 68 children experinced at least one bout of breakthrough febrile UTI.After a diagnosis of VUR,72 children (51.4%) had no record of UTI during an oral preventive dosing of antibiotics.According to univariate analysis,VUR grade (P=0.001),presence of advanced VUR (P=0.000),ureteral diameter ratio (P=0.000) and presence of bladder-bowel dysfunction (P=0.018) were associated with breakthrough febrile UTI while age,gender,VUR timing on VCUG,presence of bilateral VUR failed to reach significance (P>0.05).Based upon multivariable analysis,presence of advanced VUR[OR=2.942(1.219-7.099)]and ureteral diameter ratio[OR=1313.746(35.720-48318.362)]were among the strongest predictors of breakthrough febrile UTI.Conclusion Advanced VUR and ureteral diameter ratio >0.33 are the strongest predictors of breakthrough febrile UTI in children.
参考文献/References:
[1] Skoog SJ,Peters CA,Arant BS Jr,et al.Pediatric vesicoureteral reflux guidelines panel summary report:clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis[J].J Urol,2010,184(3):1145-1151.DOI:10.1016/j.juro.2010.05.066.
[2] Stein R,Dogan HS,Hoebeke P,et al.Urinary tract infections in children:EAU/ESPU guidelines[J].Eur Urol,2015,67(3):546-558.DOI:10.1016/j.eururo.2014.11.007.
[3] Keren R,Shaikh N,Pohl H,et al.Risk factors for recurrent urinary tract infection and renal scarring[J].Pediatrics,2015,136(1):e13-e21.DOI:10.1542/peds.2015-0409.
[4] Koyle MA,Kirsch AJ,Barone CJ 2nd,et al.Challenges in childhood urinary tract infection/vesicoureteral reflux investigation and management:calming the storm[J].Urology,2012,80(3):503-508.DOI:10.1016/j.urology.2012.06.005.
[5] Arlen AM,Kirsch AJ,Leong T,et al.Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux[J].J Pediatr Urol,2017,13(4):383.e1-383.e6.DOI:10.1016/j.jpurol.2017.01.012.
[6] Hoberman A,Greenfield SP,Mattoo TK,et al.Antimicrobial prophylaxis for children with vesicoureteral reflux[J].N Engl J Med,2014,370(25):2367-2376.DOI:10.1056/NEJMoa1401811.
[7] Garin EH.Primary vesicoureteral reflux; what have we learnt from the recently published randomized,controlled trials?[J].Pediatr Nephrol,2019,34(9):1513-1519.DOI:10.1007/s00467-018-4045-9.
[8] Szymanski KM,Oliveira LM,Silva A,et al.Analysis of indications for ureteral reimplantation in 3738 children with vesicoureteral reflux:a single institutional cohort[J].J Pediatr Urol,2011,7(6):601-610.DOI:10.1016/j.jpurol.2011.06.002.
[9] Singh-Grewal D,Macdessi J,Craig J.Circumcision for the prevention of urinary tract infection in boys:a systematic review of randomised trials and observational studies[J].Arch Dis Child,2005,90(8):853-858.DOI:10.1136/adc.2004.049353.
[10] Cooper CS,Alexander SE,Kieran K,et al.Utility of the distal ureteral diameter on VCUG for grading VUR[J].J Pediatr Urol,2015,11(4):183.e1-183.e6.DOI:10.1016/j.jpurol.2015.04.009.
[11] Swanton AR,Arlen AM,Alexander SE,et al.Inter-rater reliability of distal ureteral diameter ratio compared to grade of VUR[J].J Pediatr Urol,2017,13(2):207.e1-207.e5.DOI:10.1016/j.jpurol.2016.10.021.
[12] Arlen AM,Leong T,Guidos PJ,et al.Distal ureteral diameter ratio is predictive of breakthrough febrile urinary tract infection[J].J Urol,2017,198(6):1418-1423.DOI:10.1016/j.juro.2017.06.095.
[13] 刘鑫,刘舸,杨屹.儿童原发性膀胱输尿管反流手术干预的相关因素分析[J].临床小儿外科杂志,2019,18(10):830-834.DOI:10.3969/j.issn.1671-6353.2019.10.006.Liu X,Liu G,Yang Y.Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux[J].J Clin Ped Sur,2019,18(10):830-834.DOI:10.3969/j.issn.1671-6353.2019.10.006.
[14] Shaikh N,Hoberman A,Keren R,et al.Recurrent urinary tract infections in children with bladder and bowel dysfunction[J].Pediatrics,2016,137(1):e20152982.DOI:10.1542/peds.2015-2982.
[15] Pohl HG,de Winter JP,Milani GP.Vesicoureteral reflux:we have yet to complete our learning[J].Eur J Pediatr,2021,180(5):1381-1382.DOI:10.1007/s00431-021-03972-w.
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备注/Memo
收稿日期:2023-7-18。
基金项目:国家自然科学基金青年科学基金项目(81701531)
通讯作者:杨屹,Email:yangy2@sj-hospital.org