Swiss consensus recommendations on urinary tract infections in children
Michael Buettcher, Johannes Trueck, Anita Niederer-Loher, Ulrich Heininger, Philipp Agyeman, Sandra Asner, Christoph Berger, Julia Bielicki, Christian R. Kahlert, Lisa Kottanattu, Patrick M Meyer Sauteur, Paolo Paioni, Klara Posfay-Barbe, Christa Relly, Nicole Ritz, Petra Zimmermann, Franziska Zucol, Rita Gobet, Sandra Shavit, Christoph Rudin, Guido Laube, Rodo Von Vigier & Thomas J Neuhaus
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abstract
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The kidneys and the urinary tract are a common source of infection
in children of all ages, especially infants and young children. The
main risk factors for sequelae after urinary tract infections (UTI)
are congenital anomalies of the kidney and urinary tract (CAKUT) and
bladder-bowel dysfunction. UTI should be considered in every child
with fever without a source. The differentiation between upper and
lower UTI is crucial for appropriate management. Method of urine
collection should be based on age and risk factors. The diagnosis of
UTI requires urine analysis and significant growth of a pathogen in
culture. Treatment of UTI should be based on practical
considerations regarding age and presentation with adjustment of the
initial antimicrobial treatment according to antimicrobial
sensitivity testing. All children, regardless of age, should have an
ultrasound of the urinary tract performed after pyelonephritis. In
general, antibiotic prophylaxis is not recommended.Conclusion: Based
on recent data and in line with international guidelines,
multidisciplinary Swiss consensus recommendations were developed by
members of Swiss pediatric infectious diseases, nephrology, and
urology societies giving the clinician clear recommendations in
regard to diagnosis, type and duration of therapy, antimicrobial
treatment options, indication for imaging, and antibiotic
prophylaxis. What is Known: • Urinary tract infections (UTI)
are a common and important clinical problem in childhood. Although
children with pyelonephritis tend to present with fever, it can be
difficult on clinical grounds to distinguish cystitis from
pyelonephritis, particularly in young children less than
2 years of age. • Method of urine collection is based on
age and risk factors. The diagnosis of UTI requires urine analysis
and significant growth of a pathogen in culture. What is New: •
Vesicoureteric reflux (VUR) remains a risk factor for UTI but per se
is neither necessary nor sufficient for the development of renal
scars. Congenital anomalies of the kidney and urinary tract (CAKUT)
and bladder-bowel dysfunction play a more important role as causes
of long-term sequelae. In general, antibiotic prophylaxis is not
recommended. • A switch to oral antibiotics should be
considered already in young infants. Indications for invasive
imaging are more restrictive and reserved for patients with abnormal
renal ultrasound, complicated UTI, and infections with pathogens
other than E. coli.
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citation
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Buettcher M, Trueck J, Niederer-Loher A, Heininger U, Agyeman P,
Asner S, Berger C, Bielicki J, Kahlert C R, Kottanattu L, Meyer
Sauteur P M, Paioni P, Posfay-Barbe K, Relly C, Ritz N, Zimmermann
P, Zucol F, Gobet R, Shavit S, Rudin C, Laube G, von Vigier R,
Neuhaus T J. Swiss consensus recommendations on urinary tract
infections in children. Eur J Pediatr 2020;.
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type
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journal paper/review (English)
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date of publishing
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03-07-2020
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journal title
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Eur J Pediatr
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ISSN electronic
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1432-1076
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PubMed
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32621135
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DOI
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10.1007/s00431-020-03714-4
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