尿道感染發燒的嬰兒可以不用住院治療

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　July 13, 2009 — 根據7月份小兒科期刊發表的世代研究結果，尿道感染(urinary tract infections，UTIs)發燒的30至90天大嬰兒，可以不必住院治療。
　　
　　加拿大魁北克蒙特婁大學Sainte-Justine大學醫學中心的Marie-Joelle Dore-Bergeron醫師等人寫道，一般會要求1至3個月大、發燒的UTI嬰兒住院，並且以靜脈注射抗生素治療他們。這是首次探討發燒的UTI嬰兒以短期非住院靜脈注射抗生素治療的研究。這是個可行的治療選項，可顯著降低此年齡層UTI病童的住院天數。
　　
　　在2005年1月1日至2007年9月30日之間，總共有118名30至90天大、因為疑似發燒的UTI而在三級小兒科醫院急診的嬰兒被納入此研究。其中，67人(56.8%)在日間治療中心，如同門診病患一般，以靜脈給予抗生素，51人(43.2%)符合排除規範而住院。
　　
　　至於那些在日間治療中心治療的嬰兒，平均年紀為66天(範圍從33至85天)，有86.6%的病患確認診斷為UTI。尿液培養結果為，84.5%的嬰兒為大腸桿菌(Escherichia coli；E coli)陽性，98.3%對gentamicin有敏感性。6個嬰兒(10.3%)的血液培養結果為陽性，包括5個E coli陽性。
　　
　　日間治療中心治療的平均靜脈抗生素治療天數為2.7天，平均診視次數為2.9次，包括排洩性膀胱造影檢查約診。父母親的日間治療中心診視遵從度比率為98.3%，8.6%的嬰兒有靜脈注射問題。確認UTI的病患中，86.2%在日間治療中心接受成功的治療，成功治療的定義為完成所有的診視、溫度在48小時內恢復正常、尿液和血液培養結果為陰性、沒有從日間治療中心轉為住院。
　　
　　研究限制包括，無法推論到較無密集監控的照護單位。
　　
　　研究作者寫道，藉由在日間治療中心短期、靜脈抗生素治療，30至90天大、發燒尿道感染的嬰兒可以不用住院。藉此，可以達到極高的父母親遵從度，可以有密切的醫療監控。在這些UTI幼嬰等待安全使用口服抗生素之更多證據的時間，這個方法可以顯著降低此一年齡層UTI病患的住院天數。
　　
　　研究作者宣告沒有相關財務關係。

Ambulatory Treatment Feasible for Infants With Febrile Urinary Tract Infections

By Laurie Barclay, MD
Medscape Medical News

July 13, 2009 — Ambulatory treatment is feasible for infants aged 30 to 90 days with febrile urinary tract infections (UTIs), according to the results of a cohort study reported in the July issue of Pediatrics.

"It is common practice to hospitalize 1- to 3-month-old infants with febrile UTIs and to treat them with intravenously administered antibiotics," write Marie-Joelle Dore-Bergeron, MD, from Sainte-Justine University Hospital Center, University of Montreal in Quebec, Canada, and colleagues. "This is the first study to examine ambulatory treatment with short-term, intravenous antibiotic therapy for young infants with febrile UTIs. This treatment option is feasible and may reduce significantly the number of hospital admissions for UTIs in this age group."

Between January 1, 2005, and September 30, 2007, a total of 118 children aged 30 to 90 days were seen for presumed febrile UTIs in the emergency department of a tertiary-care pediatric hospital and enrolled in this study. Of these, 67 (56.8%) were given intravenously administered antibiotics as outpatients in a day treatment center, and 51 (43.2%) met exclusion criteria and were hospitalized.

For those infants treated in the day treatment center, median age was 66 days (age range, 33 - 85 days), and the diagnosis of UTI was confirmed for 86.6% of patients. Urine culture results were positive for Escherichia coli in 84.5% of infants, and 98.3% of isolates were sensitive to gentamicin. Six infants (10.3%) had positive blood culture results, including 5 that were positive for E coli.

Mean duration of intravenous antibiotic treatment in the day treatment center was 2.7 days, and mean number of visits was 2.9, including appointments for voiding cystourethrography. The rate of parental compliance with day treatment center visits was 98.3%, and 8.6% of infants had problems with intravenous access. Of patients with confirmed UTIs, 86.2% underwent successful treatment in the day treatment center, defined as attendance at all visits, temperature normalization within 48 hours, negative control urine and blood culture results if cultures were performed, and no hospitalization from the day treatment center.

Limitations of this study include lack of generalizability to less intensively monitored care settings.

"Ambulatory treatment of infants 30 to 90 days of age with febrile urinary tract infections by using short-term, intravenous antibiotic therapy at a day treatment center is feasible," the study authors write. "Excellent parental compliance can be achieved in this setting, which allows close medical supervision. During the wait for more evidence on the safety of oral antibiotic therapy for very young infants with UTIs, this approach may reduce significantly the number of hospital admissions for UTI treatment in this age group."

The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;124:16-22.