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Update on the approach of urinary tract infection in childhood
Ana Cristina Simões e Silva1, Eduardo Araújo Oliveira1
1Department of Pediatrics, Unit of Pediatric Nephrology, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Insights
Urinary tract infections (UTIs) in children require prompt diagnosis via urine culture to prevent kidney scarring. Management includes appropriate imaging, treatment, and considering prophylaxis in high-risk cases.
Area of Science:
- Pediatric infectious diseases
- Pediatric nephrology
- Urology
Background:
- Urinary tract infection (UTI) is the most common bacterial infection in childhood.
- UTI can indicate underlying renal abnormalities.
- Management of pediatric UTI remains a topic of debate.
Purpose of the Study:
- To review recent evidence-based recommendations for UTI diagnosis, treatment, prophylaxis, and imaging in children.
- To provide expert consensus where evidence is lacking.
Main Methods:
- Literature review.
- Searches of major scientific databases (PubMed, Embase, Scopus, SciELO).
Main Results:
- UTIs are more prevalent in boys than girls in the first year of life.
- Symptoms are often nonspecific, with fever being a common sign, especially in neonates.
- Accurate urine collection is crucial for reliable diagnosis in children.
Conclusions:
- Urine culture is essential for UTI confirmation before antibiotic administration.
- Renal and bladder ultrasonography is recommended for febrile infants with UTI.
- Prompt treatment and exclusion of obstructive uropathies are vital to prevent renal scarring; prophylaxis may be considered for susceptible individuals.
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.
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