Game Changers in Pediatrics 2011

Laurie Scudder, DNP, PNP


November 23, 2011

In This Article

Febrile UTIs in Infants

The AAP has recently published an updated Clinical Practice Guideline and technical report addressing the diagnosis and management of an initial urinary tract infection (UTI) in febrile infants and young children.[3,4] This was the first update in over 10 years and included a number of changes. The bottom line is that infants with a first febrile UTI do not automatically require a voiding cystourethrogram (VCUG). A diagnostic and management algorithm developed for the guideline helps clinicians with evaluation and management. A new study reported in November 2011 concluded that selective use of imaging after a febrile UTI did not increase the risk for recurrence.[5]

Other key findings:

  • A febrile infant deemed at low risk for UTI may be followed clinically without diagnostic testing. Infants who are higher risk may be initially assessed with a urinalysis and only require culture, collected by catheterization or suprapubic tap, if found to have a positive leukocyte esterase test results or nitrite test or microscopic analysis positive for leukocytes or bacteria.

  • Both pyuria and/or bacteriuria and the presence of at least 50,000 colony-forming U/mL of a uropathogen are required to make the diagnosis of UTI.

  • Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities and VCUG should be considered if hydronephrosis, scarring, or other findings suggestive of complex clinical circumstances found.

  • In meta-analyses of randomized controlled trials, prophylaxis for infants with vesicoureteral reflux (VUR), even those with grade 3 or 4 VUR, does not result in a lowered risk for subsequent febrile UTI.

Why Is This a Game Changer?

As S. Maria Finnell, MD, lead author of the technical report, noted in an earlier interview with Medscape, these 2 reports represent the most current and comprehensive evidence available on the topic of UTI in children 2-24 months of age. They clarify the evidence-based assessment of febrile infants with suspected UTI. Clinical judgment is paramount -- both for the first and any subsequent potential UTIs.


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