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[Synthesis of management of urinary tract infections in children]
1Centre Hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France. robert.cohen@wanadoo.fr
Insights
Pediatric urinary tract infection (UTI) management is evolving. New guidelines recommend improved diagnostics and targeted antibiotic use, reducing prophylaxis for children with UTIs.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Urology
Context:
- Urinary tract infections (UTIs) in children present diagnostic and treatment challenges.
- Emerging multidrug-resistant E. coli strains complicate management.
- Current practices for diagnosing vesico-ureteral reflux and using prophylactic antibiotics are debated.
Purpose:
- To provide updated recommendations for managing pediatric UTIs.
- To address diagnostic strategies, antibiotic therapy, and the need for reflux detection.
- To guide clinicians amidst rising antibiotic resistance.
Summary:
- Recommends increased use of urinary dipsticks and alternative urine sampling methods (e.g., catheterization) over urine bags.
- Maintains initial therapeutic proposals but emphasizes prompt susceptibility testing for effective antibiotic adjustment.
- Advocates for reduced antibiotic prophylaxis and retrograde cystography, reserving them for specific indications like recurrent UTIs or significant ultrasound abnormalities.
- Suggests increasing initial aminoglycoside monotherapy for ESBL-producing E. coli strains due to their retained activity.
Impact:
- Aims to optimize UTI diagnosis and treatment in children.
- Seeks to curb the spread of antibiotic resistance through judicious antibiotic use.
- Will help reduce unnecessary interventions, improving patient outcomes and healthcare resource allocation.
Abstract:
Management of urinary tract infections (UTI) in children is at a crossroads both in regard to the diagnostic methods used, the need to detect vesico-ureteral reflux, the benefit of prophylactic antibiotics and the emergence strains of multiresistant E. coli. The Groupe de Pathologie Infectieuse Pédiatrique of French Society of Pediatrics takes position : (i) to utilize more frequently urinary dipsticks and for urinary cultures, other methods of urine sampling than bag (sample jet, urethral catheterization, supra-pubic puncture) ; (ii) do not alter the initial therapeutic proposals of the former AFSSAPS (despite the percentage of E. coli ESBL around 10 %), but now, as soon as possible to recover the result of susceptibility testing to quickly change (for effective antibiotic treatment against a resistant strain) and to increase the proportion of children receiving initial treatment with aminoglycosides monotherapy (which remains active on the majority of ESBL strains); (iii) to reduce the prescription of antibiotic prophylaxis and retrograde cystography, except in special circumstances (recurrence, major abnormalities on ultrasound).
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