Urinary Tract Infections: An Overview of Urine Collection, Imaging, and Prevention

Abstract

IntroductionDiagnosis of UTI is common in every day pediatric clinical practice. During the fi rst 6 years of life, the annual incidence is around 1.7/1,000 for boys and 3.1/1,000 for girls, while approximately 6-7 % of girls and 2.5 % of boys will develop a UTI during this period [ 1 ]. In the fi rst 2 years of life, fUTIs prevail in both sexes, and then the rate of non febrile UTI increases, particularly in girls [ 1 , 2 ]. The rate of bacteriuria is more diffi cult to ascertain. Screening studies have demonstrated a prevalence of 1.9 % in schoolgirls and 0.2 % in schoolboys aged 5-18 years [ 3 , 4 ]. During the follow-up period of the Italian Renal Infection Study 2 [ 5 ], a randomized controlled study (RCT) carried out in order to determine the effectiveness of 12-month antimicrobial prophylaxis in preventing UTI recurrences, 2,052 urinalyses and urine cultures were performed in children of both sexes, aged between 2 and 36 months. In this cohort of children, considered to be at risk because of a previous fUTIs, with or without associated vesicoureteral refl ux, a 1.5 % rate of asymptomatic bacteriuria was detected (personal series). The management of children with a UTI has always been a matter of debate as far as diagnosis, imaging, and antibiotic prophylaxis are concerned. While some recent trials have succeeded in leading to agreement on certain issues, other important points of contention remain. Here we focus on several of the most controversial. Urine CollectionWhen a UTI is suspected, a sterile urine specimen should be collected for urinalysis and urine culture before antibiotic therapy is initiated.