1 Aug 2016
Urinary tract infections (UTIs) occur in 1 percent of boys and 3 percent of girls, with a 30 to 50 percent chance of recurrence, according to the AAUS Guidelines for UTIs in Children presented at the 14th Urological Association for Asia Congress in Singapore.
In addition, UTI is also associated with significant morbidities, including renal scar, hypertension, and chronic kidney disease, said Shang-Jen Chang from the Department of Urology at Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation in Taiwan.
UTIs in children are classified according to site (cystitis and pyelonephritis), episode (first infection and recurrent infection), severity (simple UTI and severe UTI), symptom (asymptomatic bacteriuria and symptomatic bacteriuria), and complicating factor (uncomplicated UTI and complicated UTI).
UTI diagnosis requires both positive urine culture and urinalysis that suggests infection, said Chang.
In treating UTI, the appropriate antibiotics should be given immediately after urine specimen for culture has been obtained; final antibiotic choice should be adjusted to the narrowest spectrum antibiotic when susceptibility result is available; and the choice of empirical antibiotic agents is guided by the pathogen and the local resistance patterns.
“For children with febrile UTI, the total course of antibiotic therapy should be 7 to 14 days,” said Chang, adding that “[p]rompt treatment of a febrile UTI is important to eradicate the acute infection, to prevent bacteraemia, to improve the clinical condition, and … to reduce the likelihood of renal damage.”
He also noted that antibiotics prophylaxis may be considered to prevent recurrent UTI in infants and children with or without vesicoureteral reflux (VUR) after a first UTI, but that its benefits must be weighed against the risk of antimicrobial resistance with future infections.
For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be regularly conducted as soon as possible, said Chang, before adding that top-down or bottom-up approach is recommended for VUR diagnosis.
To prevent UTI in infants and children, Chang recommends breast feeding, as well as the consumption of probiotics, cranberry and related products.
Circumcision
The risk of febrile UTI in males and breakthrough febrile UTI in males with VUR may be diminished by circumcision, according to the guidelines, but that it should only be performed if the practice is accepted by the general population.
“In countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice,” it said.