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Urinary tract infection in pediatrics: an overview
Ana Cristina Simões E Silva1, Eduardo A Oliveira1, Robert H Mak2
1Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
Insights
Pediatric urinary tract infections (UTIs) are common bacterial infections, often linked to congenital anomalies or bladder dysfunction. Diagnosis relies on urine culture, while imaging and antibiotic prophylaxis remain debated topics requiring further research.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infection (UTI) is the most frequent bacterial infection in children.
- Pediatric UTIs can signal congenital anomalies of the kidney and urinary tract (CAKUT) or bladder dysfunction.
- Escherichia coli is the predominant pathogen in community-acquired acute pyelonephritis.
Purpose of the Study:
- To critically review the pathogenesis, clinical presentation, diagnosis, imaging, treatment, chemoprophylaxis, and complications of pediatric UTIs.
- To highlight areas of ongoing debate and the need for further research in childhood UTI management.
Main Methods:
- A comprehensive, non-systematic literature search was conducted in public databases.
- Data were independently gathered and reviewed by two authors.
Main Results:
- Pediatric UTI presentation is highly variable and can be subtle.
- Urine culture remains the gold standard for diagnosis; urine collection methods require careful consideration.
- The optimal imaging protocol and the role of antibiotic prophylaxis are subjects of ongoing discussion, with a trend towards reduced prophylaxis but recognition of its benefit in select cases.
- Hypertension and chronic kidney disease are infrequently associated with UTIs in population-based studies.
Conclusions:
- Significant aspects of pediatric UTI management, particularly imaging and antibiotic prophylaxis, require further investigation.
- Longitudinal studies are essential to develop tailored approaches for managing UTIs in children.
Objective:
This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients.
Source Of Data:
Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases.
Summary Of Findings:
Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection.
Conclusion:
Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.
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