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Update of the EAU/ESPU guidelines on urinary tract infections in children
Lisette A 't Hoen1, Guy Bogaert2, Christian Radmayr3
1Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Updated European Association of Urology guidelines offer practical strategies for diagnosing and managing pediatric urinary tract infections (UTIs). These guidelines emphasize risk factor assessment to minimize invasive testing and prevent recurrent UTIs, addressing antimicrobial resistance concerns.
Area of Science:
- Pediatric Urology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are prevalent in children and can indicate underlying urinary tract abnormalities.
- Prompt diagnosis and management are crucial to prevent complications like renal scarring.
Purpose of the Study:
- To summarize the updated 2021 European Association of Urology (EAU) guidelines on the diagnosis and management of pediatric UTIs.
- To provide clinicians with practical considerations and flowcharts for evaluating and treating children with UTIs.
Main Methods:
- A structured literature review of publications between 2015 and 2020 concerning pediatric UTIs.
- Updating the EAU guidelines based on relevant new scientific literature.
Main Results:
- New risk factors (e.g., non-E. coli infection, high fever, ultrasound findings) help predict anatomical anomalies, potentially reducing the need for invasive diagnostics.
- Strategies for preventing recurrent UTIs, including antibiotic stewardship and alternative measures like bladder/bowel management, are essential.
- Antimicrobial resistance necessitates careful antibiotic use and consideration of preventative strategies.
Conclusions:
- The updated guidelines offer a practical approach to pediatric UTI management, integrating risk assessment for diagnostic workup.
- Emphasis is placed on preventing recurrent infections and renal scarring through appropriate interventions and antibiotic stewardship.
Introduction/Background:
Urinary tract infections (UTIs) are common in children and require appropriate diagnostic evaluation, management and follow-up.
Objective:
To provide a summary of the updated European Association of Urology (EAU) guidelines on Pediatric Urology, which were first published in 2015 in European Urology.
Study Design:
A structured literature review was performed of new publications between 2015 and 2020 for UTIs in children. The guideline was updated accordingly with relevant new literature.
Results:
The occurrence of a UTI can be the first indication of anatomical abnormalities in the urinary tract, especially in patients with a febrile UTI. The basic diagnostic evaluation should include sufficient investigations to exclude urinary tract abnormalities, but should also be as minimally invasive as possible. In recent years, more risk factors have been identified to predict the presence of these anatomical anomalies, such as a non-E. Coli infection, high grade fever and ultrasound abnormalities. When these risk factors are factored into the diagnostic work-up, some invasive investigations can be omitted in a larger group of children. In addition to the treatment of active UTIs, it is also essential to prevent recurrent UTIs and consequent renal scarring. With the increase of antimicrobial resistance good antibiotic stewardship is needed. In addition, alternative preventative measures such as dietary supplements, bladder and bowel management and antibiotic prophylaxis could decrease the incidence of recurrent UTI.
Conclusion:
This paper is a summary of the updated 2021 EAU guidelines on Pediatric Urology. It provides practical considerations and flowcharts for the management and diagnostic evaluation of UTIs in children.
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