Febrile Urinary Tract Infections in Children  

Oleh:

Montini, Giovanni ; Tullus, Kjell ; Hewitt, Ian

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 365 no. 03 (Jul. 2011), page 239-250.

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Perpustakaan FK Nomor Panggil: N08.K.2011.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Acute pyelonephritis is the most common serious bacterial infection in childhood; many affected children, particularly infants, have severe symptoms. Most cases are readily treated, provided diagnosis is prompt, though in some children fever may take several days to abate. Approximately 7 to 8% of girls and 2% of boys have a urinary tract infection during the first 8 years of life. Febrile urinary tract infections have the highest incidence during the first year of life in both sexes, whereas nonfebrile urinary tract infections occur predominantly in girls older than 3 years. After infancy, urinary tract infections confined to the bladder are generally accompanied by localized symptoms and are easily treated. In contrast, the presence of fever increases the probability of kidney involvement (sensitivity, 53 to 84%; specificity, 44 to 92%)3 and is associated with an increased likelihood of underlying nephrourologic abnormalities and a greater risk of consequent renal scarring. Kidney scarring related to urinary tract infection has been considered a cause of substantial long-term morbidity. Thus, children with proven infections have been intensively evaluated and treated, and they have often undergone surgery or have received long-term antibiotic prophylaxis. Such approaches have been questioned. A number of trials have been conducted or are under way to determine optimal approaches to the assessment and management of initial febrile urinary tract infections and subsequent interventions for them. This review summarizes the diverse views on this controversial topic.

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