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Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)

Seung Joo Lee
대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2015.10|Childhood Kidney Diseases (Childhood Kidney diseases)|제19권 제2호|pp. 56-64

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참고문헌

키워드

PreventionTreatmentRecognitionDiagnosisImaging studies
주제분류소아과학

초록

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. 99mTc-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

Abstract

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. 99mTc-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

참고문헌 (51)

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관련 논문AI추천

Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection김세윤, 박용훈, 임명희, 장경미대한소아신장학회 · Childhood Kidney Diseases2017 · 제21권 제2호New Insights for Febrile Urinary Tract Infection (Acute Pyelonephritis) in Children이경일대한소아신장학회 · Childhood Kidney Diseases2016 · 제20권 제2호방광요관역류에서 예방적 항생제요법의 최신 지견김준모대한요로생식기감염학회 · Urogenital Tract Infection2011 · 제6권 제1호대구지역 소아청소년과 의사들의 요로감염 관리 실태분석강석정, 박용훈, 이상수, 이재민, 조민현대한소아신장학회 · Childhood Kidney Diseases2012 · 제16권 제2호영아에서의 열성 요로감염: 일차성과 재발성 감염의 비교분석공도훈, 이상돈, 정석근대한요로생식기감염학회 · Urogenital Tract Infection2011 · 제6권 제2호Prognostic Factors of Renal Scarring on Follow-up DMSA Scan in Children with Acute PyelonephritisByung Woo Woo, Hae Sook Kim, Juyeen Lee대한소아신장학회 · Childhood Kidney Diseases2016 · 제20권 제2호

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