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Evaluation and Management of Urinary Tract Infections in Children

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Pediatric Surgery

Abstract

Urinary tract infections (UTI) represent a major infectious etiology of morbidity in children. Over the past two decades, the approach to evaluation and management of factors associated with the pathogenesis of UTI have evolved, at times leading to the publication of new guidelines. With increasing evidence, individualized approaches to the child with febrile and non-febrile UTI need to relate to age, sex, potty trained (or not), and social factors.

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References

  • Austin PF. The role of alpha blockers in children with dysfunctional voiding. Sci World J. 2009;9:880–3.

    Article  CAS  Google Scholar 

  • Austin P, et al. alpha-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol. 1999;162:1064–7.

    Article  CAS  PubMed  Google Scholar 

  • Austin PF, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2014; https://doi.org/10.1016/j.juro.2014.01.110.

  • Borch L, Hagstroem S, Bower WF, Siggaard Rittig C, Rittig S. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr. 2013;102:e215–20.

    Article  PubMed  Google Scholar 

  • Brandström P, Lindén M. How Swedish guidelines on urinary tract infections in children compare to Canadian, American and European guidelines. Acta Paediatr. 2021;110(6):1759–71. https://doi.org/10.1111/apa.15727. Epub 2020 Dec 31.PMID: 33341101.

    Article  PubMed  Google Scholar 

  • Brandström P, Jodal U, Sillén U, Hansson S. The Swedish reflux trial: review of a randomized, controlled trial in children with dilating vesicoureteral reflux. J Pediatr Urol. 2011;7:594–600.

    Article  PubMed  Google Scholar 

  • Burgers RE, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013a;190:29–36.

    Article  PubMed  Google Scholar 

  • Burgers R, et al. Functional defecation disorders in children with lower urinary tract symptoms. J Urol. 2013b;189:1886–91.

    Article  PubMed  Google Scholar 

  • Cain M, Wu S, Austin P, Herndon C, Rink R. Alpha blocker therapy for children with dysfunctional voiding and urinary retention. ET J. 2003;170:1514–5.

    CAS  Google Scholar 

  • Caza M, Kronstad JW. Shared and distinct mechanisms of iron acquisition by bacterial and fungal pathogens of humans. Front Cell Infect Microbiol. 2013;3. https://doi.org/10.3389/fcimb.2013.00080.

  • Cleper R. Prevalence of vesicoureteral reflux in neonatal urinary tract infection. Clin Pediatr (Phila). 2004;43:619–25.

    Article  PubMed  Google Scholar 

  • Craig JC, Williams GJ. Denominators do matter: it’s a myth--urinary tract infection does not cause chronic kidney disease. Pediatrics. 2011;128:984–5.

    Article  PubMed  Google Scholar 

  • Craig JC, Wheeler DM, Irwig L, Howman-Giles RB. How accurate is dimercaptosuccinic acid scintigraphy for the diagnosis of acute pyelonephritis? A meta-analysis of experimental studies. J Nucl Med. 2000;41:986–93.

    CAS  PubMed  Google Scholar 

  • Craig JC, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009;361:1748–59.

    Article  CAS  PubMed  Google Scholar 

  • Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA. Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol. 2011;7:342–8.

    Article  PubMed  Google Scholar 

  • Dhakal BK, Kulesus RR, Mulvey MA. Mechanisms and consequences of bladder cell invasion by uropathogenic Escherichia coli. Eur J Clin Invest. 2008;38:2–11. https://doi.org/10.1111/j.1365-2362.2008.01986.x.

  • Farhat W, et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000;164:1011–5.

    Article  CAS  PubMed  Google Scholar 

  • Farhat W, McLorie G, O’Reilly S, Khoury A, Bagli D. Reliability of the pediatric dysfunctional voiding symptom score in monitoring response to behavioral modification. Can J Urol. 2001;8:1401–5.

    CAS  PubMed  Google Scholar 

  • Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–84. https://doi.org/10.1038/nrmicro3432.

  • Franco I, Landau-Dyer L, Isom-Batz G, Collett T, Reda EF. The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children. J Urol. 2007;178:1775–80.

    Article  CAS  PubMed  Google Scholar 

  • Garin EH. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006;117:626–32.

    Article  PubMed  Google Scholar 

  • Heaton KW, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992;33:818–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Heyns CF. Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol. 2011;30:77–83.

    Article  PubMed  Google Scholar 

  • Hinman F. Nonneurogenic neurogenic bladder (the Hinman syndrome) - 15 years later. J Urol. 1986;136:769–77.

    Article  PubMed  Google Scholar 

  • Hoberman A, et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348:195–202.

    Article  PubMed  Google Scholar 

  • Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2007;4

    Google Scholar 

  • Joensson IM, Siggaard C, Rittig S, Hagstroem S, Djurhuus JC. Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J Urol. 2008;179:1997–2002.

    Article  PubMed  Google Scholar 

  • Kauffman CA. Diagnosis and management of fungal urinary tract infection. Infect Dis Clin North Am. 2014;28(1):61–74. https://doi.org/10.1016/j.idc.2013.09.004.

  • Kilic N, Balkan E, Akgoz S, Sen N, Dogruyol H. Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability. Int J Urol. 2006;13:105–8.

    Article  CAS  PubMed  Google Scholar 

  • KoçyiÄŸit A, Yüksel S, Bayram R, Yılmaz Ä°, Karabulut N. Efficacy of magnetic resonance urography in detecting renal scars in children with vesicoureteral reflux. Pediatr Nephrol. 2014;29:1215–20.

    Article  PubMed  Google Scholar 

  • Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998;160:1019–22.

    Article  CAS  PubMed  Google Scholar 

  • Kotoula A, et al. Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection. Urology. 2009;73:782–6.

    Article  PubMed  Google Scholar 

  • Kovanlikaya A, et al. Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol. 2004;49:76–80.

    Article  PubMed  Google Scholar 

  • Koyle MA, et al. Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int. 2011;27:337–46.

    Article  PubMed  Google Scholar 

  • La Scola C, et al. Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 2013;131:e665–71.

    Article  PubMed  Google Scholar 

  • Lachenmyer LL, et al. Analysis of an intervention to reduce parental anxiety prior to voiding cystourethrogram. J Pediatr Urol. 2013;9:1223–8.

    Article  PubMed  Google Scholar 

  • Lane MC, Mobley HLT. Role of P-fimbrial-mediated adherence in pyelonephritis and persistence of uropathogenic Escherichia coli (UPEC) in the mammalian kidney. Kidney Int. 2007;72(1):19–25. https://doi.org/10.1038/sj.ki.5002230.

  • Laupland KB, Ross T, Pitout JDD, Church DL, Gregson DB. Community-onset Urinary tract infections: a population-based assessment. Infection. 2007;35(3):150–3. https://doi.org/10.1007/s15010-007-6180-2.

  • Lee LC, Lorenzo AJ, Koyle MA. The role of voiding cystourethrography in the investigation of children with urinary tract infections. Can Urol Assoc J. 2016;10(5–6):210–4. https://doi.org/10.5489/cuaj.3610. PMID: 27713802.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leroy S, et al. Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 2013;131:870–9.

    Article  PubMed  Google Scholar 

  • Liao P-F, et al. Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging. Pediatr Nephrol. 2014;29:1567–74.

    Article  PubMed  Google Scholar 

  • Lopez P-J, Celis S, Reed F, Zubieta R. Vesicoureteral reflux: current management in children. Curr Urol Rep. 2014;15

    Google Scholar 

  • Mangera A, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65:981–90.

    Article  CAS  PubMed  Google Scholar 

  • Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021;147(2):e2020012138. https://doi.org/10.1542/peds.2020-012138. PMID: 33479164.

    Article  PubMed  Google Scholar 

  • Montini G, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008;122:1064–71.

    Article  PubMed  Google Scholar 

  • National Institute of Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and long-term management. at http://www.nice.org.uk/nicemedia/pdf/CG54fullguideline.pdf

  • Paduch DA. Viral lower urinary tract infections. Curr Prostate Rep. 2007;5(1):40–50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Petronijevic V, et al. Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding. J Urol. 2007;178:2599–603.

    Article  CAS  PubMed  Google Scholar 

  • Pohl HG, et al. The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. BJU Int. 2002;89:923–7.

    Article  CAS  PubMed  Google Scholar 

  • Radojicic ZI, Perovic SV, Milic NM. Is it reasonable to treat refractory voiding dysfunction in children with botulinum-A toxin? J Urol. 2006;176:332–6.

    Article  PubMed  Google Scholar 

  • Rosenberg HK, Ilaslan H, Finkelstein MS. Work-up of urinary tract infection in infants and children. Ultrasound Q. 2001;17:87–102.

    Article  CAS  PubMed  Google Scholar 

  • Salo J, Ikaheimo R, Tapiainen T, Uhari M. Childhood urinary tract infections as a cause of chronic kidney disease. Pediatrics. 2011;128:840–7.

    Article  PubMed  Google Scholar 

  • Shaikh N, et al. Does this child have a urinary tract infection? JAMA. 2007;298:2895–904.

    Article  CAS  PubMed  Google Scholar 

  • Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27:302–8.

    Article  PubMed  Google Scholar 

  • Shaikh N, Craig JC, Rovers MM, et al. Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatr. 2014;168(10):893. https://doi.org/10.1001/jamapediatrics.2014.637.

  • Shaikh N, Borrell JL, Evron J, Leeflang MM. in Cochrane database of systematic reviews (ed. The Cochrane Collaboration). Wiley; 2015. at http://doi.wiley.com/10.1002/14651858.CD009185.pub2.

  • Singh-Grewal D. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005;90:853–958.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Srivastava T, Betts G, Rosenberg AR, Kainer G. Perception of fear, distress and pain by parents of children undergoing a micturating cystourethrogram: a prospective study. J Paediatr Child Health. 2001;37:271–3.

    Article  CAS  PubMed  Google Scholar 

  • Stein R, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 2015;67:546–58.

    Article  PubMed  Google Scholar 

  • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595–610.

    Article  Google Scholar 

  • ‘t Hoen LA, Bogaert G, Radmayr C, Dogan HS, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Bhatt NR, Stein R. Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol 2021;17(2):200–207. https://doi.org/10.1016/j.jpurol.2021.01.037. Epub 2021 Feb 2.PMID: 33589366.

    Article  PubMed  Google Scholar 

  • The RIVUR Trial Investigators. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014:140504000112001. https://doi.org/10.1056/NEJMoa1401811.

  • Yucel S, et al. Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. ET J. 2005;174:1612–5.

    CAS  Google Scholar 

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Lee, L.C., Penna, F.J., Koyle, M.A. (2022). Evaluation and Management of Urinary Tract Infections in Children. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_165-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_165-1

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