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尿路感染症・年齢別画像診断の適応(NICEガイドラインより)

VCUGの適応が限られていることに注意。
アメリカ小児科学会のガイドラインではUTI全例に超音波検査が推奨されている。
出典
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1: Urinary tract infection in children, National Institute for Health and Clinical Excellence.
Arch Dis Child Educ Pract Ed. 2007 Dec;92(6):189-92. doi: 10.1136/adc.2007.130799.

各種尿検査による尿路感染症診断の感度・特異度

エステラーゼテストおよび亜硝酸反応のどちらかが陽性とすることで、感度が90%以上となる。また、亜硝酸反応は特異度が高い。
出典
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1: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.
著者: Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB.
雑誌名: Pediatrics. 2011 Sep;128(3):595-610. doi: 10.1542/peds.2011-1330. Epub 2011 Aug 28.
Abstract/Text: OBJECTIVE: To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children.
METHODS: Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded.
RESULTS: Diagnosis is made on the basis of the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances. VCUG should also be performed if there is a recurrence of a febrile UTI. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care; variations may be appropriate. Recommendations about antimicrobial prophylaxis and implications for performance of VCUG are based on currently available evidence. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study.
CONCLUSIONS: Changes in this revision include criteria for the diagnosis of UTI and recommendations for imaging.
Pediatrics. 2011 Sep;128(3):595-610. doi: 10.1542/peds.2011-1330. Epub...

小児の尿路感染症における抗生剤の選択

尿培養の結果が出るまではEmpiricalな治療を開始し、後に起炎菌、薬剤感受性を踏まえて、抗菌薬を変更する。
 
参考文献:
日本感染症学会・日本化学療法学会、JAID/JSC感染症治療ガイド・ガイドライン作成委員会編:JAID/JSC感染症治療ガイド2023. p.299-304, ライフサイエンス出版, 2023を参考に作図
出典
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1: 著者提供

排尿時膀胱造影による膀胱尿管逆流の評価

膀胱尿管逆流(右II度、左III度)を認める。
a:膀胱尿管逆流Ⅲ度
b:膀胱尿管逆流Ⅱ度
出典
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1: Bennett, John E., MD, et al.: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 9th ed. 72. Urinary Tract Infections, Fig.72-5. Elsevier, 2020

腎膿瘍、腎周囲膿瘍

腹部超音波で腎周囲に膿瘍を認める。腹部CTでは右腎内にも巣状の膿瘍を認める。MRSAによる膿瘍。
a:腹部超音波
b:腹部CT
出典
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1: Kliegman, Robert M., MD, et al: Nelson Textbook of Pediatrics, 21st ed. 553. Urinary Tract Infections, Figure 553-4. Elsevier, 2020

腎シンチグラム

急性腎盂腎炎と腎瘢痕を示す両側の集積欠損 (DMSAシンチ)
LPO:左後斜位
RPO:右後斜位
出典
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1: Kliegman, Robert M., MD, et al: Nelson Textbook of Pediatrics, 21st ed. 553. Urinary Tract Infections, Figure 553-8. Elsevier, 2020

尿路感染症・年齢別画像診断の適応(NICEガイドラインより)

VCUGの適応が限られていることに注意。
アメリカ小児科学会のガイドラインではUTI全例に超音波検査が推奨されている。
出典
imgimg
1: Urinary tract infection in children, National Institute for Health and Clinical Excellence.
Arch Dis Child Educ Pract Ed. 2007 Dec;92(6):189-92. doi: 10.1136/adc.2007.130799.

各種尿検査による尿路感染症診断の感度・特異度

エステラーゼテストおよび亜硝酸反応のどちらかが陽性とすることで、感度が90%以上となる。また、亜硝酸反応は特異度が高い。
出典
imgimg
1: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.
著者: Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB.
雑誌名: Pediatrics. 2011 Sep;128(3):595-610. doi: 10.1542/peds.2011-1330. Epub 2011 Aug 28.
Abstract/Text: OBJECTIVE: To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children.
METHODS: Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded.
RESULTS: Diagnosis is made on the basis of the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances. VCUG should also be performed if there is a recurrence of a febrile UTI. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care; variations may be appropriate. Recommendations about antimicrobial prophylaxis and implications for performance of VCUG are based on currently available evidence. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study.
CONCLUSIONS: Changes in this revision include criteria for the diagnosis of UTI and recommendations for imaging.
Pediatrics. 2011 Sep;128(3):595-610. doi: 10.1542/peds.2011-1330. Epub...