Contemporary Management of Urinary Tract Infection in Children

Abstract

Urinary tract infection (UTI) is common in children, and girls are at a significantly higher risk, as compared to boys, except in early infancy. Most cases are caused by Escherichia coli. Collection of an uncontaminated urine specimen is essential for accurate diagnosis. Oral antibiotic therapy for 7 to 10 days is adequate for uncomplicated cases that respond well to the treatment. A renal ultrasound examination is advised in all young children with first febrile UTI and in older children with recurrent UTI. Most children with first febrile UTI do not need a voiding cystourethrogram; it may be considered after the first UTI in children with abnormal renal and bladder ultrasound examination or a UTI caused by atypical pathogen, complex clinical course, or known renal scarring. Long-term antibiotic prophylaxis is used selectively in high-risk patients. Few patients diagnosed with vesicoureteral reflux after a UTI need surgical correction. The most consequential long-term complication of acute pyelonephritis is renal scarring, which may increase the risk of hypertension or chronic kidney disease later in life. Treatment of acute pyelonephritis with an appropriate antibiotic within 48 hours of fever onset and prevention of recurrent UTI lowers the risk of renal scarring. Pathogens causing UTI are increasingly becoming resistant to commonly used antibiotics, and their indiscriminate use in doubtful cases of UTI must be discouraged.

Management of paediatric recurrent urinary tract infections and challenges in special patient populations

“…1 Up to 30% of these children will experience at least one recurrence within 6-12 months. 2,3 While 3-15% of children with a first UTI will show renal parenchymal scarring within 1-2 years of their first UTI, [4][5][6][7] the risk of acquired chronic kidney disease remains low. 5,8 An rUTI can be defined as a repeated presentation with separate episodes of cystitis, pyelonephritis or urosepsis.…”

“…As a result of non-specific presentations of fever and general distress in infants, it is important to consider UTI as part of the differential diagnosis. 5,13 A febrile infant younger than three months of age should be promptly managed in accordance with local guidelines, 14 which in certain circumstances may recommend management on the basis of clinical suspicion without awaiting confirmatory testing.…”

“…It is important to consider not only the quickest or simplest collection method, but also one that will yield the cleanest sample free of contaminants. 5,13 To diagnose a UTI, suspicion of infection must be clinically correlated to both of the following criteria: 13…”

“…18 Avoidance of bubble baths, which can cause mucosal irritation and genital discomfort, is recommended to decrease mimics of an impending UTI. 5 Parents can refer to several resources when learning about good hygiene practices for children, namely Raising Children Network (https://raisingchildren. net.au) 24 and The Royal Children's Hospital Melbourne (RCH), which provide information regarding penis and foreskin care.…”

“…32 Overall, CAP should be considered in high-risk populations that are susceptible to rUTIs and at risk of renal damage. 5,21 Patients with both VUR and BBD are at the highest risk of rUTI 5,33 and may benefit most from CAP. 34 The antimicrobial options for CAP are included in Table 4.…”