Materials and methods
Epidemiology and aetiology
- 1.Classification according to site.
- 2.Classification according to severity.
- 3.Classification according to episode.
- 4.Classification according to symptoms.
- 5.Classification according to complicating factors.
Medical history and clinical evaluation
- 1.Plastic bag attached to the cleaned genitalia. This has a high risk of contamination in about 50–60% []; however, it is helpful when the results are negative to rule out a UTI.
- 2.Clean-catch urine (CCU) collection where spontaneous voiding, with or without tapping or massaging, is collected in a sterile bowl. This has lower contamination rates of approximately 26% [,]; however, it is again helpful when the results are negative to rule out a UTI.
- 3.Transurethral bladder catheterisation is a fast and safe way to obtain a reliable urine sample with a contamination rate of about 10% []. Urine collected this way can be used for urine cultures.
- 4.Suprapubic bladder aspiration is the most invasive method to obtain urine samples with contamination rates of approximately 1% [] and these samples can be used for urine cultures as well.
- 3.Flow imaging analysis technology
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- Salounova D.
- Havelka J.
- Kraft O.
- Sirucek P.
- Kocvara R.
- et al.
- Mola G.
- Wenger T.R.
- Salomonsson P.
- Knudsen I.J.D.
- Madsen J.L.
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- Bryce A.
- Hay A.D.
- Lane I.F.
- Thornton H.V.
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- Costelloe C.
- Kahbazi M.
- Sharafkhah M.
- Yousefichaijan P.
- Taherahmadi H.
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Monitoring of UTI
Conflict of interest/funding
|Summary of evidence||LE|
|Urinary tract infection represents the most common bacterial infection in children less than 2 years of age. The incidence varies depending on age and sex.||1b|
|Classifications are made according to the site, episode, severity, symptoms and complicating factors.|
For acute treatment, site and severity are most important.
|The number of colony forming units (cfu) in the urine culture can vary, however, any colony count of one specimen indicates a high suspicion for UTI||2b|
|Due to increasing resistance numbers good antibiotic stewardship should guide the choice of antibiotics, taking into account local resistance patterns, old urine cultures (when available) and clinical parameters.||2a|
|Preventive measures against recurrent UTIs include: chemoprophylaxis (oral and intravesical), cranberries, probiotics and Vitamin A and E.||2a|
|During acute UTI both DMSA and diffusion-weighted MRI can confirm pyelonephritis or parenchymal damage.||2a|
|Take a medical history, assess clinical signs and symptoms and perform a physical examination to diagnose children suspected of having a urinary tract infection (UTI).||3||Strong|
|Exclude bladder- and bowel dysfunction in any toilet-trained child with febrile and/or recurrent UTI.||3||Strong|
|Clean catch urine can be used for screening forUTI. Bladder catheterisation and suprapubic bladder aspiration to collect urine can be used for urine cultures.||2a||Strong|
|Do not use plastic bags for urine sampling in non-toilet-trained children since it has a high risk of false-positive results.||2a||Strong|
|Midstream urine is an acceptable technique for toilet-trained children.||2a||Strong|
|The choice between oral and parenteral therapy should be based on patient age; clinical suspicion of urosepsis; illness severity; refusal of fluids, food and/or oral medication; vomiting; diarrhea; non-compliance; complicated pyelonephritis.||2a||Strong|
|Treat febrile UTIs with four to seven day courses of oral or parenteral therapy.||1b||Strong|
|Treat complicated febrile UTI with broad-spectrum antibiotics||1b||Strong|
|Offer long-term antibacterial prophylaxis in case of high susceptibility to UTI and risk of acquired renal damage and lower urinary tract symptoms.||1b||Strong|
|In selected cases consider dietary supplements as an alternative or add-on preventive measure.||2a||Strong|
|In infants with febrile UTI use renal and bladder ultrasound to exclude obstruction of the upper and lower urinary tract within 24 h||2a||Strong|
|In infants, exclude VUR after first epidose of febrile UTI with a non-E. Coli infection. In children more than one year of age with an E. Coli infection, exclude VUR after the second febrile UTI.||2a||Strong|
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