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Urinary tract infections in infants and children: a comprehensive overview
1Department of Pediatrics, University of Pittsburgh School of Medicine, PA, USA. Ellen.Wald@chp.edu
Insights
Pyuria, indicated by 10 leukocytes/mm3 in unspun urine, is a valuable indicator for urine cultures in infants. Current evidence does not support routine antimicrobial prophylaxis or surgical intervention for pediatric urinary tract infections with reflux.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common serious bacterial infections in young children.
- Accurate diagnosis and management are crucial to prevent long-term complications like renal scarring.
Purpose of the Study:
- To review recent literature (August 2002-August 2003) on diagnosing and managing UTIs in infants and children.
- To evaluate the effectiveness of diagnostic tests and imaging studies for pediatric UTIs.
Main Methods:
- Literature review focusing on new additions from August 2002 to August 2003.
- Analysis of studies on pyuria as a predictor of positive urine cultures.
- Evaluation of imaging studies, particularly voiding cystourethrogram (VCUG), for detecting vesicoureteral reflux (VUR).
Main Results:
- Pyuria (≥10 leukocytes/mm3 in unspun urine) is a strong predictor for warranting a urine culture in at-risk infants.
- Vesicoureteral reflux (VUR) findings on VCUG can be variable, potentially leading to under- or overestimation of reflux severity.
- Lower grades of VUR (1-3) show spontaneous resolution rates of approximately 13% per year.
- There is no current evidence to prove that antimicrobial prophylaxis or surgical intervention prevents reinfection or renal scarring in children with VUR.
Conclusions:
- The assumption that interventions for VUR prevent renal scarring remains unproven.
- A randomized, controlled prospective trial comparing antimicrobial prophylaxis to no treatment for children with VUR is necessary.
Purpose Of Review:
Urinary tract infections are the most common serious bacterial infections in infants and young children. This review focuses on new additions to the literature for the period August 22, 2002, to August 21, 2003.
Recent Findings:
There is still considerable interest in determining which test is best to predict the likelihood of a positive urine culture in children at risk for urinary tract infection. One new analysis and several older analyses suggest that the finding of pyuria, as measured by at least 10 leukocytes/mm3 on unspun urine is a very valuable cutoff for identifying infants for whom urine culture is warranted. Several new investigations have studied the value of various imaging studies in children with urinary tract infections. It has been shown that the finding of vesicoureteral reflux is variable and that single studies may underestimate or overestimate the degree of reflux. The natural history for lower grades of reflux (grades 1, 2, and 3) is spontaneous resolution at a rate of 13% per year. The rationale for the determination of the degree of reflux by voiding cystourethrogram is to guide the institution of antimicrobial prophylaxis or surgical intervention until the reflux resolves. This is based on the assumption, as yet unproven, that these interventions will prevent or decrease reinfection and thereby prevent the development of renal scarring. Data are presented indicating that there is still no evidence that this assumption is correct.
Summary:
Continued attention to the need for and benefit of imaging procedures in children with urinary tract infection mandates that there be a randomized, controlled prospective trial of antimicrobial prophylaxis versus no treatment for children with various degrees of reflux.