Revised statement on management of urinary tract infections (original) (raw)

Review Article Highlights for Management of a Child with a Urinary Tract Infection

Urinary tract infections remain the most common bacterial infection in childhood. Escherichia coli is responsible for over 80% of Pediatric UTIs. Other common gram negative organisms include Kleibsiella, Proteus, Enterobacter and occasionally Pseudomonas. Signs and symptoms vary greatly by age of the patient becoming more specific as the child grows older. Even in the absence of specific signs a UTI should be included in the differential diagnosis of high grade fever. In younger children, presence of upper respiratory infections, otitis media or gastroenteritis does not eliminate the possibility of a UTI. Culture of the urine remains the gold standard for diagnosing UTIs. All males and females with well documented UTIs should be imaged for the presence of urological anomalies associated with UTI. Depending on patient's clinical symptoms and tolerance, therapy can be oral or parenteral as they have both been found equally efficacious. Healthcare professionals should ensure that when a child or young person has been identified as having a suspected UTI, they and their parents are given information about the need for treatment, the importance of completing any course of treatment and advice about prevention and possible long-term management.

Pediatric urinary tract infection (UTI)

2021

This work is licensed under a Creative Commons BY-NC-SA 4.0 International License. AB S T R AC T Urinary tract infections (UTIs) are prevalent in the children. Presentation of UTI vary in children of different ages. In infants, who cannot localize symptoms, UTI can present with a fever whereas in older children a UTI can present with urinary symptoms (dysuria, urinary frequency, incontinence). It is important to establish a clear diagnosis in order to treat and resolve the infection with antibiotics therapy to prevent bacteremia, pyelonephritis, and long-tern renal disease. Urine is collected through a mid-stream urine sample, in toilet trained children, via urethral catheterization, suprapubic aspiration and pediatric urine collection bags. Urine analysis and culture are the first-line investigations in children with suspected UTI. Goals of treatment include elimination of infection, relief of acute symptoms, and prevention of recurrent and long-term complications. The Canadian Ped...

Evaluation and Management of Pediatric Urinary Tract Infections

Urologic Clinics of North America, 1999

Urinary tract infections (UTIs) in childhood are neither rare nor insignificant. They can be harbingers of potential underlying anatomic abnormalities. As a result, children in whom UTIs develop routinely undergo an anatomic evaluation when adults may not. The management of UTIs in children also differs from management in adults. This article describes a rational approach to the evaluation and management of childhood UTIs with relation to the natural history and risk factors.

Urinary Tract Infections in Children: EAU/ESPU Guidelines

European urology, 2015

In 30% of children with urinary tract anomalies, urinary tract infection (UTI) can be the first sign. Failure to identify patients at risk can result in damage to the upper urinary tract. To provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI. The recommendations were developed after a review of the literature and a search of PubMed and Embase. A consensus decision was adopted when evidence was low. UTIs are classified according to site, episode, symptoms, and complicating factors. For acute treatment, site and severity are the most important. Urine sampling by suprapubic aspiration or catheterisation has a low contamination rate and confirms UTI. Using a plastic bag to collect urine, a UTI can only be excluded if the dipstick is negative for both leukocyte esterase and nitrite or microscopic analysis is negative for both pyuria and bacteriuria. A clean voided midstream urine sample after cleaning the external genitalia has good diagnost...

Paediatric urinary tract infections: Diagnosis and treatment

Australian family physician, 2016

Urinary tract infections (UTIs) commonly occur in children. An estimated 8% of girls and 2% of boys will have at least one episode by seven years of age. Of these children, 12-30% will experience recurrence within one year. Australian hospital admission records indicate that paediatric UTIs represent 12% of all UTI hospital admissions. The aim of this article is to review the pathogenesis, clinical assessment and management of UTIs, and prevention strategies in children. Clinically, paediatric UTI presentations are challenging because symptoms are vague and variable. Young infants may present with sepsis or fever and lack specific symptoms, whereas older children present with classical features such as dysuria, frequency and loin pain. Early diagnosis with appropriate urine specimen collection techniques, investigations and treatment is necessary for prevention of renal damage and recurrence. Effective, evidence-based investigations and treatment options are available, and physician...

Urinary Tract Infection in Children: A Review of the Established Practice Guidelines

2020

Urinary tract infection (UTI) is a significant cause of morbidity in children. Delayed treatment is associated with complications that may result in chronic kidney disease and, subsequently, end-stage kidney disease. Over the years, clinical practice guidelines have advanced to ensure the best global practices in treating the infection and preventing its progression to chronic kidney disease. The established practice guidelines address five main questions: 1) which children should have their urine tested; 2) how the sample should be obtained; 3) which radiological tests are recommended after a diagnosis of UTI; 4) how the infection should be treated; 5) and how affected children should be followed up. There is a substantial overlap in the recommendations of the American Academy of Pediatrics (AAP) guidelines and the UK’s National Institute for Health and Clinical Excellence (NICE) guidelines. Subtle differences, however, exist between the two established guidelines. An evidence-base...

Urinary Tract Infections in Children: A Hospital-Based Study

SVOA Paediatrics, 2023

Introduction Urinary tract infection is an acute illness usually accompanied by fever, with or without other constitutional symptoms, and local signs of loin tenderness and bladder inflammation. Upper urinary tract infection (acute pyelonephritis) may lead to kidney scarring, hypertension, and end-stage kidney disease. Although children with pyelonephritis tend to present with fever, it is often difficult on clinical grounds to distinguish cystitis from pyelonephritis, particularly in smaller children (those younger than 2 years). UTI is a common and important clinical problem in paediatric population, and it can cause many complications. If not discover and treated early, it will cause discomfort to patient and worry to family. The majority of children with UTI has a good prognosis. However, some may develop seizure or long-term complication especially if it's recurrent or if the patient has a malformation like reflux. Obstructive malformation occurs in 2% of girls and 10% of boys while the gross reflux may present in 5% within the infantile group. During the first year of life (1,2), 5%-10% of febrile UTI may complicated with kidney scar or reflux nephropathy,10%-26% of asymptomatic bacteriuria among the school age girl may have also Kidney scar or reflux nephropathy. (3,4) However, children with recurrent UTI are prone to some complication like hypertension, stones or end-stage renal disease, all these complications can be avoided by good treatment and appropriate care. Acute management of urinary tract infection consists of antimicrobial therapy to treat the acute infection and evaluation of possible predisposing factors such as obstructive and congenital uropathies.

Contemporary Management of Urinary Tract Infections in Children

Current Treatment Options in Pediatrics

Purpose of Review Urinary tract infection (UTI) in children is a major source of office visits and healthcare expenditure. Research into the diagnosis, treatment, and prophylaxis of UTI has evolved over the past 10 years. The development of new imaging techniques and UTI screening tools has improved our diagnostic accuracy tremendously. Identifying who to treat is imperative as the increase in multi-drug-resistant organisms has emphasized the need for antibiotic stewardship. This review covers the contemporary management of children with UTI and the data-driven paradigm shifts that have been implemented into clinical practice. Recent Findings With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant Pediatric Urology (BA VanderBrink and RP Pramod, Section Editors) alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on Escherichia coli may change the way we treat children with recurrent UTIs. Summary The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. E. coli is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.