Urinary Tract Infections

Bottom Line Recommendations for diagnosis and treatment of urinary tract infections - French. Version 1.1.

Bottom Line Recommendations for diagnosis and treatment of urinary tract infection. Version 1.1

Bottom Line Recommendations for diagnosis and treatment of urinary tract infections - French. Version 1.1.

This summary presents key diagnostic risk factors for urinary tract infections (UTIs) in children. The summary also covers diagnostic investigations and treatment algorithms for uncomplicated and complicated UTIs.

This clinical pathway contains diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

These guidelines provide assessment and management information for children with urinary tract infections.

These guidelines contain diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

This quality standard covers diagnosing and managing urinary tract infection in infants, children and young people (under 16). It includes new and recurrent infections of the upper or lower urinary tract. It describes high-quality care in priority areas for improvement.

These pathways contain diagnosis and treatment guidance for urinary tract infections in a range of patients (outpatients, inpatients) of different ages (infants, children and adolescents) and presentations (atypical and typical).

This article reaffirms the 2011 American Academy of Pediatrics' Urinary Tract Infection Clinical Practice Guidelines and provides an updated review of the supporting evidence.

These European Association of Urology/European Society for Pediatric Urology guidelines provide recommendations for the diagnosis, treatment, and imaging of children presenting with urinary tract infections.

The Canadian Paediatric Society practice statement focuses on the diagnosis and management of infants and children >2 months of age with an acute urinary tract infection and no known underlying urinary tract pathology or risk factors for a neurogenic bladder.

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

These guidelines revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children.

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

We wanted to find out if oral antibiotics were as effective as combined oral and injected antibiotics to treat children for kidney infection. This review updates our previous investigations published in 2003, 2005 and 2007. This review included evidence from 27 studies that involved 4452 children. The last literature search date was April 2014. This update included evidence from three new studies and from one study that was previously excluded. Review results suggested that children aged over one month with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten or amoxicillin/clavulanic acid) or with short courses (two to four days) of intravenous (IV) therapy followed by oral therapy. If IV therapy with aminoglycosides is needed, single daily dosing is safe and effective.

Covert bacteriuria occurs when bacteria are found in urine either during routine screening or incidentally during other investigations. Unlike urinary tract infections, children with covert bacteriuria do not appear to have symptoms at the time of diagnosis. There is uncertainty about whether antibiotic treatment can help to clear infection, reduce recurrence, or prevent kidney damage. Any harmful effects of providing treatment also need to be identified and understood. We identified three studies reporting the results on 460 girls. There was insufficient evidence about the harms and benefits of treatments to draw reliable conclusions, but it appears that antibiotic treatment is not likely to benefit children in the long term.

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Bladder and kidney infections (urinary tract infection - UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long-term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long-term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

This review assessed rapid urine tests for the diagnosis of urinary tract infection in children and concluded that no one test could identify all urinary tract infections without urine culture, but Gram-stain microscopy was the best single test. Dipstick tests should be considered positive if either leucocyte esterase or nitrite was positive. These conclusions are likely to be reliable.

The review assessed the accuracy of C-reactiveproteinfor diagnosingbacterial infectionsin febrile children and used robust reviewing and meta-analytic methods. The authors' conclusion that C-reactive protein provided moderate and independent information for ruling-in and ruling-out seriousbacterial infection, but cannot be used alone to exclude bacterial infection, is likely to be reliable.

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. This review aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines.

This review presents summary recommendations for diagnosing urinary tract infection in children.

In this manuscript, the authors review the diagnosis and management of acute and recurrent urinary tract infection in the paediatric and adolescent populations.

Objectives: To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance.

This review discusses the management and laboratory diagnoses of urinary tract infections in children. Important factors, such as specimen collection, urinalysis interpretation, culture thresholds, and antimicrobial susceptibility testing are covered.

This systematic review addressed the questions: Compared to placebo or no therapy, did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality, when used to prevent UTI in susceptible patient populations? Compared to other prophylactic interventions, including drug and non-drug measures (e.g. continuous antibiotic prophylaxis, topical oestrogen, cranberry juice), did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality when used to prevent UTIs in susceptible patient populations?

The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein, erythrocyte sedimentation rate can replace the acute DMSA scan in the diagnostic evaluation of children with urinary tract infections; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other.

The objectives of this review were to evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration.

The authors review both early and emerging literature to examine the utility and efficacy of early identification and treatment of urinary tract infection in children younger than 24 months.

This review aims to summarise the benefits and harms of antibiotics for treating lower urinary tract infection in children.

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

The objectives of this review are to revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children.

The objectives of this review are to determine the efficacy and harms of long-term antibiotics to prevent recurrent urinary tract infections in children.

Rapid urine tests, such as microscopy, for bacteria and white cells, and dipsticks, for leucocyte esterase and nitrites, are often used in children that are unwell to guide early diagnosis and treatment of urinary tract infection. This review aimed to establish whether these tests were sufficiently sensitive to avoid urine culture in children with negative results and to compare the accuracy of dipsticks with microscopy.

This article reviews the diagnostic accuracy of symptoms and signs for the diagnosis of urinary tract infection in infants and children.

The objectives of this systematic review are to determine the diagnostic accuracy of tests for detecting urinary tract infection (UTI) in children under 5 years of age and to evaluate the effectiveness of tests used to investigate further children with confirmed UTI. Also, to evaluate the effectiveness of following up children with UTI and the cost-effectiveness of diagnostic and imaging tests for the diagnosis and follow-up of UTI in children under 5. An additional objective was to develop a preliminary diagnostic algorithm for healthcare professionals.

This systematic review was conducted to determine the diagnostic accuracy of rapid tests for detecting urinary tract infection in children under five years of age.

The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute urinary tract infection in children.

The objective of this study is to develop and test a calculator (UTICalc) that can first estimate the probability of urinary tract infection based on clinical variables and then update that probability based on laboratory results.

This study evaluated the test characteristics of the urinalysis for diagnosing urinary tract infections, with and without associated bacteremia, in young febrile infants.

This study evaluated the controversial relationship between the duration of fever before treatment initiation for a febrile urinary tract infection, with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.

This study assessed the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the emergency department. We also examined whether the 2011 American Academy of Pediatrics UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

The objective of this study was to develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.

Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. The aim of this study was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment.

The objective of this study was to determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials.

The objective of this study was to determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections is associated with the occurrence and severity of renal scarring.

The objective of this study was to determine the pathogens in positive urine cultures from hospitalized and non-hospitalized infants under 24 months of age.

The objective of this study was to evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.

The purpose of this study was to determine the accuracy (sensitivity and specificity) of urinalysis for diagnosing urinary tract infection in infants <3 months of age.

The objective of this study was to test whether active management of urinary tract infections in young children by general practitioners can reduce kidney scarring rates.

This study aimed to determine the variation in patient disposition for young febrile infants who present to emergency departments with urinary tract infections and clinical factors independently associated with outpatient management.

The objectives of this study were to determine how the sensitivity of the standard urinalysis as a screening test for urinary tract infection varies with age, and to determine the clinical situation that necessitates the collection of a urine culture regardless of the urinalysis result.

The objective of this study wa to compare rapid tests and screening strategies for detecting urinary tract infection in infants.

The objective of this study was to determine whether the absence of pyuria on the enhanced urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.

Urinary tract infections (UTIs) are a bacterial infection of the urinary tract (kidneys, ureters, bladder, and urethra). They can occur at any stage of life and symptoms may be different depending on your child’s age. This video provides information about symptoms, when to seek medical care, and how to manage and prevent UTIs in children.

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Urinary tract infections (UTIs) are a bacterial infection of the urinary tract (kidneys, ureters, bladder, and urethra). They can occur at any stage of life and symptoms may be different depending on your child’s age. This interactive infographic provides information about symptoms, when to seek medical care, and how to manage and prevent UTIs in children.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Episode 123: On the one hand, UTI is one of the most common bacterial infections in children younger than 2 years of age and could lead to sepsis acutely and theoretically renal failure in the long run. On the other hand, it is important not to over-diagnose UTIs because we know that overuse of antibiotics increases costs, side effects and leads to antibiotic resistance. The first principles questions very much apply here: who to screen, how to screen, and what to do with the screen results. There are risks associated with not having a standardized approach to diagnosing pediatric UTIs. In this EM Cases main episode podcast with Dr. Olivia Ostrow and Dr. Michelle Science we discuss an approach to diagnosing pediatric UTIs whilst revealing some common pediatric UTI myths and misperceptions. Published online: April 2019