Diagnosing urinary tract infection in pediatric age group especially infants has been a challenge. Here are the guidelines of American Academy of Pediatrics (AAP) to stream line its treatment and diagnosis.

Team@CMHF

Since the introduction of effective vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae, there has been increasing recognition of the urinary tract as the frequent site of occult and serious bacterial infection in febrile infants and children. Because of the nonspecific clinical findings and inability to obtain reliable urine specimens without invasive measure, the diagnosis and treatment of urinary tract infections (UTIs) may be delayed. In 1999, the American Academy of Pediatrics (AAP) developed clinical practice guidelines for the diagnosis and treatment of UTIs in febrile infants and young children.

The aim of this study was to report the revisions to the AAP practice parameter regarding the diagnosis and management of initial UTIs in febrile infants and young children.

The diagnosis and management of …UTIs in young children are clinically challenging,” write S. Maria E. Finnell, MD, MS, and colleagues from the AAP Subcommittee on Urinary Tract Infection who coauthored the technical report. “This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age

AAP Recommendations

Specific recommendations in the new Clinical Practice Guideline include the following:

• Diagnosis of UTI is made from an appropriately collected urine specimen based on the presence of pyuria as well as 50,000 colonies per mL or more of a single uropathogenic organism.
• To facilitate prompt diagnosis and treatment of recurrent UTIs, close clinical follow-up monitoring should be maintained after 7 to 14 days of antimicrobial therapy.
• To diagnose anatomic abnormalities, ultrasonography of the kidneys and bladder should be performed.
• Because evidence from the most recent 6 studies does not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without VUR or with grade 1 to 4 VUR, VCUG is not recommended routinely after the first UTI.
• However, VCUG is indicated if renal and bladder ultrasonography results show hydronephrosis, scarring, or other evidence of high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances.
• Infants and children who have recurrence of a febrile UTI should also undergo VCUG.

Additional comments in response to the 5 clinical questions addressed in the guideline and technical report, include the following
Which children should have their urine tested?
How should the urine sample be obtained?
How should UTIs be treated?
What imaging and follow-up are recommended after a diagnosis of UTI?
How should children be monitored after a UTI has been diagnosed?

Clinical Implications

• Diagnosis of a UTI in febrile infants and children 2 to 24 months old includes the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine.
• Febrile infants with UTIs should have a renal and bladder ultrasound examination; however, a VCUG is no longer recommended routinely after the first UTI.

Ref: http://www.medscape.org/viewarticle/748932?src=cmemp