The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections

Abstract

Urinary tract infection (UTI) is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute UTI and recurrent UTI in children remain controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent UTI in the pediatric population.

Keywords:

• diagnosis
• management
• nephrology
• pyelonephritis
• urinary tract infection
• urology

Acknowledgements

The authors of this manuscript have no financial disclosures. JDS is supported by the National Institute of Health Grant K08DK094970-03.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Urinary tract infection (UTI) is one of the most common bacterial infections in children.

• Rapid diagnosis and prompt therapy are critical in the prevention of long-term UTI sequelae.

• Because UTI can present with vague clinical complaints, UTI should be considered in any infant or child presenting with fever without an identifiable source of infection.

• UTI diagnosis requires both the urinalysis demonstrating evidence of pyuria and the presence of >50,000 CFU/ml of a single uropathogen in an appropriately collected urine specimen.

• The American Academy of Pediatrics suggests that a 7- to 14-day course of antibiotic therapy is sufficient UTI treatment.

• Although voiding cystourethrography is no longer recommended after the first febrile UTI, renal and bladder ultrasound is recommended.

• Evidence regarding the utility of continuous antibiotic prophylaxis in recurrent UTI prevention has been obtained almost exclusively in the setting of vesicoureteral reflux and remains largely inconclusive.

• UTI pathogenesis is not clearly defined. As we further understand UTI pathogenesis, we may be able to develop treatments or preventative strategies that do not depend on conventional antibiotics.