Related Experiment Video
Updated: Feb 15, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
A critical review of recent clinical practice guidelines for pediatric urinary tract infection
Michael Chua1,2, Jessica Ming1, Shang-Jen Chang3
1Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
High-quality pediatric urinary tract infection (UTI) guidelines from Spain, AAP, and NICE offer consistent recommendations for diagnosis and management. These guidelines demonstrate strong adherence to quality standards for development.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Inconsistencies in pediatric urinary tract infection (UTI) clinical practice guidelines raise concerns about quality and applicability.
- Evaluating the rigor and consistency of existing pediatric UTI guidelines is crucial for establishing a reliable standard of care.
Purpose of the Study:
- To assess the quality of recent pediatric UTI clinical practice guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument.
- To summarize the diagnostic and management standards for pediatric UTI from leading guidelines.
Main Methods:
- Systematic literature search for English-language pediatric UTI clinical practice guidelines (2007-2016).
- Independent appraisal of eligible guidelines by six reviewers using the AGREE II tool.
- Assessment of inter-rater reliability using inter-class coefficient (ICC).
Main Results:
- Thirteen clinical practice guidelines were reviewed; Spanish, AAP, and NICE guidelines scored highest on AGREE II domains (90, 88, 88).
- High inter-rater reliability (ICC 0.938, p<0.0001) was observed among reviewers.
- Significant consensus exists among the top three guidelines regarding major recommendations for pediatric UTI.
Conclusions:
- Pediatric UTI clinical practice guidelines from Spain, the American Academy of Pediatrics (AAP), and the National Institute for Health and Clinical Excellence (NICE) demonstrate high quality.
- These leading guidelines exhibit strong adherence to AGREE II quality indicators in their development process.
- The consensus among these top guidelines provides a reliable foundation for pediatric UTI diagnosis and management.
Introduction:
Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. We aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines.
Methods:
A systematic literature search was performed on medical literature electronic databases and international guideline repository websites. English language-based clinical practice guidelines from 2007-2016 endorsed by any international society or government organization providing recommendations for the management of pediatric UTI were considered. Eligible clinical practice guidelines were independently appraised by six reviewers using the AGREE II tool. Clinical practice guidelines were assessed for standardized domains and summarized for overall quality. Inter-rater reliability was assessed using inter-class coefficient (ICC).
Results:
Thirteen clinical practice guidelines were critically reviewed. The Spanish clinical practice guidelines, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence clinical practice guidelines consistently scored high on all AGREE domains (total averaged domain scores 90, 88, and 88, respectively). Among the six reviewers, there was a high degree of inter-rater reliability (average measure ICC 0.938; p<0.0001). There is reasonable consensus among the top three clinical practice guidelines in their major recommendations.
Conclusions:
The clinical practice guidelines from Spain, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence, with their major recommendations being similar, have scored highly on the AGREE II indicators of quality for the clinical practice guidelines development process.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:17Urinary Tract Infection IV: Nursing Management
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Urinary Tract Calculi I: Introduction