Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.
TLDR
Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux or with grade I to IV VUR, and a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI.Abstract:
OBJECTIVE: To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. METHODS: Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded. RESULTS: Diagnosis is made on the basis of the presence of both pyuria and at least 50 000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances. VCUG should also be performed if there is a recurrence of a febrile UTI. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care; variations may be appropriate. Recommendations about antimicrobial prophylaxis and implications for performance of VCUG are based on currently available evidence. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study. CONCLUSIONS: Changes in this revision include criteria for the diagnosis of UTI and recommendations for imaging.read more
Citations
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Journal ArticleDOI
Antimicrobial prophylaxis for children with vesicoureteral reflux.
Alejandro Hoberman,Saul P. Greenfield,Tej K. Mattoo,Ron Keren,Ranjiv Mathews,Hans G. Pohl,Bradley P. Kropp,Steven J. Skoog,Caleb P. Nelson,Marva Moxey-Mims,Russell W. Chesney,Myra A. Carpenter +11 more
TL;DR: Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring.
Journal ArticleDOI
A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology
J. Michael Miller,Matthew J. Binnicker,Sheldon Campbell,Karen C. Carroll,Kimberle C. Chapin,Peter H. Gilligan,Mark D. Gonzalez,Robert C. Jerris,Sue C. Kehl,Robin Patel,Bobbi S. Pritt,Sandra S. Richter,Barbara Robinson-Dunn,Joseph D. Schwartzman,James W. Snyder,Sam R. Telford,Elitza S. Theel,Richard B. Thomson,Melvin P. Weinstein,Joseph D. Yao +19 more
TL;DR: This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions.
Journal ArticleDOI
Urinary Tract Infections in Children: EAU/ESPU Guidelines
Raimund Stein,Hasan Serkan Dogan,Piet Hoebeke,Radim Kocvara,Rien J.M. Nijman,Christian Radmayr,Serdar Tekgul +6 more
TL;DR: These guidelines provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI and advise exclusion of obstructive uropathy within 24h and later vesicoureteral reflux, if indicated.
Reference EntryDOI
Antibiotics for acute pyelonephritis in children
TL;DR: It is suggested that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2-4 days) of IV therapy followed by oral therapy and if IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective.
Journal ArticleDOI
A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections
Nathan Kuppermann,Peter S. Dayan,Deborah Levine,Melissa A. Vitale,Leah Tzimenatos,Michael G. Tunik,Mary Saunders,Mary Saunders,Richard M. Ruddy,Richard M. Ruddy,Genie Roosevelt,Alexander J. Rogers,Elizabeth C. Powell,Lise E. Nigrovic,Jared T. Muenzer,Jared T. Muenzer,James G. Linakis,James G. Linakis,Kathleen Grisanti,David M. Jaffe,John D. Hoyle,John D. Hoyle,Richard Greenberg,Rajender Gattu,Andrea T. Cruz,Ellen F. Crain,Daniel M. Cohen,Daniel M. Cohen,Anne F. Brayer,Dominic A. Borgialli,Dominic A. Borgialli,Bema K. Bonsu,Bema K. Bonsu,Lorin R. Browne,Stephen Blumberg,Jonathan E. Bennett,Shireen M. Atabaki,Jennifer Anders,Elizabeth R. Alpern,Elizabeth R. Alpern,Benjamin Miller,T. Charles Casper,J. Michael Dean,Octavio Ramilo,Octavio Ramilo,Prashant Mahajan,Prashant Mahajan +46 more
TL;DR: An accurate prediction rule to identify febrile infants 60 days and younger at low risk for SBIs using the urinalysis, ANC, and procalcitonin levels is derived and validated.
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Book
Textbook of pediatric infectious diseases
Ralph D. Feigin,James D. Cherry +1 more
TL;DR: Textbook of pediatric infectious diseases, Textbook of Pediatrics , کتابخانه دیجیتال جندی شاپور اهواز
Journal ArticleDOI
Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children
Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection.
David A. Bergman,Richard D. Baltz,James R. Cooley,Liaison Representatives,Michael J. Goldberg,Sections Liason,Gerald B. Hickson,Charles J. Homer,Paul V. Miles,Joan E. Shook,William M. Zurthellen,Betty A. Lowe,Nachri Liaison,Kenneth B. Roberts,Stephen M. Downs,Stanley Hellerstein,Michael J. Holmes,Robert L. Lebowitz,Jacob A. Lohr +18 more
TL;DR: Eleven recommendations are proposed for the diagnosis, management, and follow-up evaluation of infants and young children with unexplained fever who are later found to have a diagnosed UTI.
Journal ArticleDOI
Imaging Studies after a First Febrile Urinary Tract Infection in Young Children
Alejandro Hoberman,Martin Charron,Robert W. Hickey,Marc N. Baskin,Diana H. Kearney,Ellen R. Wald +5 more
TL;DR: An ultrasonogram performed at the time of acute illness is of limited value, and a voiding cystourethrogram for the identification of reflux is useful only if antimicrobial prophylaxis is effective in reducing reinfections and renal scarring.