抗生素英文课件精品—— Diagnosis and Management of VUR after first UTI教程文件.pptVIP

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抗生素英文课件精品—— Diagnosis and Management of VUR after first UTI教程文件.ppt

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教学课件课件PPT医学培训课件教育资源教材讲义

Potential Harms and Costs VCUG and RNC are invasive and cause physical discomfort and psychological distress. VCUG involves exposure to ionizing radiation. Diagnosis of VUR and perceived risk of renal scarring causes anxiety to patient and family. Prophylactic antibiotics contribute to antimicrobial resistance in the patient and the community. Recurrent UTIs with bacteria resistant to Cefotaxime = 27% in children receiving prophylactic antibiotics v. 3% in children not receiving them (RR=9.9; 95% CI [4-24.5]). (Lutter et al., Antibiotic resistance patterns in children hospitalized for UTIs, APAM, 2006) Costs of diagnosis and treatment potentially great. So now that we’ve discussed the epidemiology and pathogenesis of UTIs, let’s proceed to a case and answer some specific questions using the best evidence found in the literature. X = dies * * * * Dilating VUR (Grades 3-5) Normal DMSA Abnormal DMSA No VUR 36 64 VUR 1-2 5 16 VUR 3-5 0 21 Normal DMSA Abnormal DMSA No VUR 133 105 VUR 1-2 7 18 VUR 3-5 1 26 “Top Down” Approach Perform DMSA within 30 days of UTI Normal: reassure parents that kidneys are normal and child unlikely to have dilating VUR ? skip the VCUG Abnormal: obtain VCUG, consider antibiotics v. surgery if VUR present, repeat DMSA in 4-6 months to diagnose scars “Top Down” Approach Spares a lot of children a VCUG (48% in Preda study) DMSA less than half the radiation of a VCUG DMSA less invasive than a VCUG DMSA gives information about the health of the kidneys, which can be followed over time. No Work-up Defer work-up until 2nd or 3rd UTI Heightened vigilance Educate on early signs and symptoms Emphasize need for rapid diagnosis Treat dysfunctional elimination ?Provide urine collection kits and dip sticks Likely that early diagnosis and treatment will prevent most UTI-related scarring. Copyright ?2007 American Academy of Pediatrics Doganis, D. et al. Pediatrics 2007;120:e922-e928 DMSA results in the acute phase and day of treatment Refer to RIVUR stud