兒童尿路感染：不需昂貴檢查，簡單血液測試可判斷嚴重程度

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研究發現，對於兒童尿路感染的診斷，可以使用簡單的血液測試，而不需昂貴的技術檢查。當無法進行技術性的檢查時，如果患兒發燒超過2天且C-反應蛋白（CRP）超過66.4 mg/L，或者發燒不超過2天且CRP超過27.3 mg/L，可以合理地將其視為嚴重的尿路感染。這一發現將有助於更迅速和準確地診斷兒童的尿路感染，並提供適當的治療。

急性腎盂腎炎與兒童下尿道感染的臨床鑑別

Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children

Huang DT, Huang FY, Tsai TC, Tsai JD, Chiu NC, Lin CC. Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children. J Microbiol Immunol Infect. 2007 Dec;40(6):513-7. PMID: 18087632.

https://pubmed.ncbi.nlm.nih.gov/18087632/

Abstract

 To evaluate clinical variables for diagnosing childhood acute pyelonephritis (APN) when technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy is not available.

We retrospectively reviewed the records of 590 children with febrile UTI seen from January 1999 to February 2004. On the basis of DMSA scintigraphy performed within 7 days after admission, they were divided into APN (n = 237) or non-APN (n = 353) groups. Gender, age, clinical presentation, absolute neutrophil count, C-reactive protein (CRP), urinalysis, culture, and sonographic findings were recorded from charts.

A CRP level of > or =66.4 mg/L, in patients with >2 days prior to admission had a sensitivity of 71.6% and a specificity of 72.5% for APN. Similarly, a CRP of >27.3 mg/L in patients with < or =2 days prior to admission and a white cell count of >14,990/mm3 had sensitivities of 68.6% and 62.0% and specificities of 66.1% and 63.0%, respectively. Combining two or more variables did not result in better discrimination.

If a DMSA scan is not available, it is reasonable to treat a febrile UTI as APN if the CRP is >66.4 mg/L in a patient with >2 days of fever or if the CRP is >27.3 mg/L in a patient febrile for < or =2 days.

摘要

評估臨床變數以診斷兒童急性腎盂腎炎（APN），當技術性99m二巯基琥珀酸（DMSA）放射性核種掃描不可用時。

我們回顧性地查閱了1999年1月至2004年2月間診治的590名發燒性尿路感染（UTI）兒童的病歷記錄。根據在入院後7天內進行的DMSA核素掃描結果，將他們分為APN組（n = 237）或非APN組（n = 353）。從病歷中記錄了性別、年齡、臨床表現、絕對中性粒細胞計數、C-反應蛋白（CRP）、尿液分析、培養和超聲波檢查結果。

在入院前>2天的CRP水平≥66.4 mg/L的患者中，對於APN的敏感性為71.6％，特異性為72.5％。同樣，在入院前≤2天的CRP>27.3 mg/L和白細胞計數>14,990/mm3的患者，其敏感性分別為68.6％和62.0％，特異性分別為66.1％和63.0％。結合兩個或更多變數並未導致更好的區別。

如果DMSA掃描不可用，則合理地將發燒性UTI視為APN，如果患者發燒超過2天，CRP>66.4 mg/L；或者如果患者發燒不超過2天，CRP>27.3 mg/L。