Update on the approach of urinary tract infection in childhood

J Pediatr (Rio J). 2015 Nov-Dec;91(6 Suppl 1):S2-10. doi: 10.1016/j.jped.2015.05.003. Epub 2015 Sep 7.

Abstract

Objective: Urinary tract infection (UTI) is the most common bacterial infection in childhood. UTI may be the sentinel event for underlying renal abnormality. There are still many controversies regarding proper management of UTI. In this review article, the authors discuss recent recommendations for the diagnosis, treatment, prophylaxis, and imaging of UTI in childhood based on evidence, and when this is lacking, based on expert consensus.

Sources: Data were obtained after a review of the literature and a search of Pubmed, Embase, Scopus, and Scielo.

Summary of the findings: In the first year of life, UTIs are more common in boys (3.7%) than in girls (2%). Signs and symptoms of UTI are very nonspecific, especially in neonates and during childhood; in many cases, fever is the only symptom.

Conclusions: Clinical history and physical examination may suggest UTI, but confirmation should be made by urine culture, which must be performed before any antimicrobial agent is given. During childhood, the proper collection of urine is essential to avoid false-positive results. Prompt diagnosis and initiation of treatment is important to prevent long-term renal scarring. Febrile infants with UTIs should undergo renal and bladder ultrasonography. Intravenous antibacterial agents are recommended for neonates and young infants. The authors also advise exclusion of obstructive uropathies as soon as possible and later vesicoureteral reflux, if indicated. Prophylaxis should be considered for cases of high susceptibility to UTI and high risk of renal damage.

Keywords: CAKUT; Cicatriz renal; Hidronefrose; Hydronephrosis; Infecção do trato urinário; Obstructive uropathy; Renal scarring; Ultrasonography; Ultrassonografia; Urinary tract infection; Uropatia obstrutiva.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Cicatrix / etiology
  • Cicatrix / prevention & control
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney / pathology
  • Male
  • Recurrence
  • Ultrasonography
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / prevention & control
  • Urine Specimen Collection / methods
  • Urogenital Abnormalities / diagnostic imaging
  • Urogenital Abnormalities / prevention & control
  • Vesico-Ureteral Reflux / diagnostic imaging
  • Vesico-Ureteral Reflux / prevention & control

Substances

  • Anti-Bacterial Agents

Supplementary concepts

  • Cakut