Update of the EAU/ESPU guidelines on urinary tract infections in children

Hoen, Lisette A. ’t; Bogaert, Guy; Radmayr, Christian; Doğan, Hasan Serkan; Nijman, Rien J.M.; Quaedackers, Josine; Rawashdeh, Yazan F.; Sılay, Mesrur Selçuk; Tekgül, Serdar; Bhatt, Nikita; Stein, Raimund

doi:10.1016/j.jpurol.2021.01.037

Cited by 90 publications

(91 citation statements)

References 56 publications

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“…11 Accordingly, diagnosis continues to rely on bacterial culture of urine samples. 6,9 In the present study, bacterial cultures were performed for all patients during hospitalization and for some patients during follow-up. Bladder urine samples for bacterial culture were also collected during DJC withdrawal.…”

Section: Discussionmentioning

confidence: 99%

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Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters

et al. 2021

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Objectives To investigate the pathogens and potential risk factors for urinary tract infection (UTI) in patients with retained double-J catheters (DJCs). Methods In total, 107 infants and young children with DJCs were included in this retrospective analysis. Patients were included in the infection group (n = 30) or non-infection group (n = 77), according to UTI presence or absence. The species and characteristics of pathogens were investigated, and the clinical features of the patients were recorded for further analysis. Results Gram-negative bacilli were the most common causative pathogens (69.2%), among which Escherichia coli was most frequent (38.5%). The second most common causative pathogens were Gram-positive cocci (28.2%), among which Enterococcus faecalis was most frequent (10.3%). UTIs among patients in this study were associated with the following factors: catheter retention (long-term) (odds ratio [OR] = 2.514, 95% confidence interval [CI] = 1.176–5.373), sex (male) (OR = 2.966, 95% CI = 1.032–8.529), DJC retention (long-term) (OR = 1.869, 95% CI = 1.194–2.926), and DJC number (unilateral) (OR = 0.309, 95% CI = 0.103–0.922). Conclusions Infants and young children with DJCs were likely to experience UTIs, mainly caused by Gram-negative bacilli. Long-term catheter retention or DJC retention, male sex, and bilateral DJC retention were risk factors for UTI.

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Section: Discussionmentioning

confidence: 99%

“…UTI diagnostic criteria were based on European Association of Urology Guidelines on Paediatric Urology: UTI was defined as a bacterial colony count >10 5 colony-forming units/ mL. 9 Pathogen identification was performed using the BD Phoenix-100 automatic microbial identification analyzer (BD, Franklin Lakes, NJ, USA).…”

Section: Participants and Uti Assessmentmentioning

confidence: 99%

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters

et al. 2021

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“…under the acronym “the ESKAPE pathogens”, capable of “escaping” the bactericidal action of antibiotics [ 7 , 8 ]. This group of bacteria represents a challenge for empirical antibiotic treatment of complicated UTI [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of UTI begins immediately after a urine specimen for culture is collected and before the culture results are available and then changing to specific therapy based on uropathogens sensibility [ 9 , 10 , 11 , 12 ]. The treatment aims to eradicate the infection, prevent bacteriemia, relieve the symptoms, improve the clinical condition, avert complications, and prevent renal scarring [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines for empirical antibiotic treatment of complicated UTI recommend amoxicillin/clavulanic acid or cefotaxime/ceftriaxone administered intravenously and then switching to oral as soon as the clinical condition permits it. The treatment duration must be 10 days for pyelonephritis and 14 days for urosepsis [ 9 , 12 , 14 ]. Bacterial resistance is a public health issue all over the world.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract

Isac

Basaca²,

Olariu

et al. 2021

Children

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Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.

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Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults

Nelson,

Tarık Aslan,

Beahm

et al. 2024

JAMA Netw Open

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ImportanceTraditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.ObjectiveTo create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength.Evidence ReviewThis consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches.FindingsA total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.Conclusions and RelevanceIn this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.

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Update of the EAU/ESPU guidelines on urinary tract infections in children

Cited by 90 publications

References 56 publications

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters

Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract

Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults

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