抗生素PPT课件（英文精品） VUR, UTI, and Antibiotic ProphylaxisPPT.ppt

* VUR, UTI, and Antibiotic ProphylaxisHow to Use an Article About Therapy or Prevention Journal Club Amy K Evans PGY2 August 15, 2006 The Case Kali is a 14mo female who presents to WRAMC ED with fever to 102. Your stellar Peds Intern suggests obtaining a UA/UCx, which results in the diagnosis of acute pyelonephritis. The Case Kali is a 14mo female who presents to WRAMC ED with fever to 102. Your stellar Peds Intern suggests obtaining a UA/UCx, which results in the diagnosis of acute pyelonephritis. Kali is admitted to Wd51 for 48hrs of IV abx, then, afebrile, discharged to complete po course. The Case Kali is a 14mo female who presents to WRAMC ED with fever to 102. Your stellar Peds Intern suggests obtaining a UA/UCx, which results in the diagnosis of acute pyelonephritis. Kali is admitted to Wd51 for 48hrs of IV abx, then, afebrile, discharged to complete po course. She undergoes renal US and VCUG 3 weeks later, which reveal grade II VUR on the left. The Question Should we treat her prophylactically? Short-term: Will this decrease recurrent infections? Long-term: Will this decrease renal scarring? Why else would it matter? Background Incidence 1-10% Siblings 30-45% (3/4 asymptomatic) Diagnosed via VCUG UTI workup – 40% (girls); 70% (infants 1yo) Antenatal hydronephrosis – 9% (boys) Why worry? VUR ? pyelonephritis ? renal scarring ? HTN, renal insufficiency, ESRD, pre-eclampsia Background Natural hx of VUR: spontaneous resolution UTI ? VUR? ■ VUR ? UTI? VUR ? Pyelo? ■ VUR ? Scarring? Current Treatment Recs Workup: Febrile UTI (any age) UTI 5yo UTI x2 in school-age girls UTI in any boy To treat or not to treat? Imaging: Renal US 40% sensitive (VUR) VCUG Diagnostic! DMSA AUA Treatment Guidelines Grade Age (y) Scarring Treatment Follow-Up I-II Any +/- Abx prophy No consensus III-IV 0-5 +/- Abx prophy Surgery III-IV 6-10 +/- Unilat: abx Bilat: surgery Surgery V 1 +/- Abx prophy Surgery V 1-5 - Unilat: abx Bilat: surgery Surgery V 1-5 + Surgery V