Urinary Tract Infection in Children: An Update

Abstract

The 2011 American Academy of Pediatrics (AAP) Urinary Tract Infection (UTI):Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2-24 Months guideline addressed “areas for research” identifying multiple areas where evidence at the time of the publication was lacking. This review discussed the evidence development in those identified areas. In this paper, I will review the latest literature on UTI in children and focus on those areas of research suggested in these guidelines. I will also summarize the related literature since September 2011. Literature related to first UTI in children have contributed important new knowledge since the publication of the 2011 AAP guideline; 1) additional research has failed to clarify the relationship between childhood UTI and adult renal function. 2) High grade vesicoureteral reflux (VUR) has been established as a clear risk factor for scarring, but the condition is rare. Abnormal ultrasound, and fever in combination with non-E coli infection are other important predictors of scarring. 3) Antimicrobial prophylaxis appear to decrease UTI recurrences, but a large amount of antibiotics has to be administrated to prevent one UTI and the prevention works best in children with low grade, not high grade, VUR, 4) cranberry juice may prevent UTI, and 5) new, less aggressive guidelines, seem not to have negative consequences for pediatric patients measured as missed true pathology. Future guidelines would benefit from incorporating this new information.