Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection

  • Choi, Da Min (Department of Pediatrics, Korea University College of Medicine) ;
  • Heo, Tae Hoon (Department of Pediatrics, Korea University College of Medicine) ;
  • Yim, Hyung Eun (Department of Pediatrics, Korea University College of Medicine) ;
  • Yoo, Kee Hwan (Department of Pediatrics, Korea University College of Medicine)
  • Received : 2014.08.26
  • Accepted : 2014.10.31
  • Published : 2015.09.10
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Abstract

Purpose: To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods: We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results: A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion: UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

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References

  1. Jack SE. Urinary tract infections. In: Kliegman RM, Stanton B, St. Geme JW III, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier Saunders, 2011:1829-34.
  2. Edefonti A, Tel F, Testa S, De Palma D. Febrile urinary tract infections: clinical and laboratory diagnosis, imaging, and prognosis. Semin Nucl Med 2014;44:123-8. https://doi.org/10.1053/j.semnuclmed.2013.10.004
  3. Lee SJ. Guidelines for childhood urinary tract infection. Korean J Pediatr 2009;52:976-83. https://doi.org/10.3345/kjp.2009.52.9.976
  4. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610. https://doi.org/10.1542/peds.2011-1330
  5. Ahn HS, editor. Hong Chang-Yee textbook of pediatrics.10th ed. Seoul: MiraeN Co., 2012.
  6. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993;23:478-80. https://doi.org/10.1007/BF02012459
  7. Benador D, Benador N, Slosman D, Mermillod B, Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet 1997;349:17-9. https://doi.org/10.1016/S0140-6736(96)06126-0
  8. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 1985;15:105-9. https://doi.org/10.1007/BF02388714
  9. Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ 2007;335:395-7. https://doi.org/10.1136/bmj.39286.700891.AD
  10. Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Am Fam Physician 2005;71:1153-62.
  11. Al-Daghistani HI, Abdel-Dayem M. Diagnostic value of various urine tests in the Jordanian population with urinary tract infection. Clin Chem Lab Med 2002;40:1048-51.
  12. Pecile P, Miorin E, Romanello C, Falleti E, Valent F, Giacomuzzi F, et al. Procalcitonin: a marker of severity of acute pyelonephritis among children. Pediatrics 2004;114:e249-54. https://doi.org/10.1542/peds.114.2.e249
  13. Jung JI, Lim DH, Yim HE, Park MS, Yoo KH, Hong YS, et al. Fever duration and renal scar in pediatric urinary tract infection. J Korean Soc Pediatr Nephrol 2008;12:70-7. https://doi.org/10.3339/jkspn.2008.12.1.70
  14. Choi L, Cho SE, Yim HE, Yoo KH, Hong YS, Lee JW. Clinical significance of pyuria in pediatric patients with febrile urinary tract infection. J Korean Soc Pediatr Nephrol 2011;15:66-75. https://doi.org/10.3339/jkspn.2011.15.1.66
  15. Kanellopoulos TA, Vassilakos PJ, Kantzis M, Ellina A, Kolonitsiou F, Papanastasiou DA. Low bacterial count urinary tract infections in infants and young children. Eur J Pediatr 2005;164:355-61. https://doi.org/10.1007/s00431-005-1632-0
  16. Hansson S, Brandstrom P, Jodal U, Larsson P. Low bacterial counts in infants with urinary tract infection. J Pediatr 1998;132:180-2. https://doi.org/10.1016/S0022-3476(98)70512-8
  17. Levtchenko EN, Lahy C, Levy J, Ham HR, Piepsz A. Role of Tc-99m DMSA scintigraphy in the diagnosis of culture negative pyelonephritis. Pediatr Nephrol 2001;16:503-6. https://doi.org/10.1007/s004670100591
  18. Nammalwar BR, Vijayakumar M, Sankar J, Ramnath B, Prahlad N. Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis. Indian Pediatr 2005;42:691-6.
  19. Montini G, Zucchetta P, Tomasi L, Talenti E, Rigamonti W, Picco G, et al. Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1. Pediatrics 2009;123:e239-46. https://doi.org/10.1542/peds.2008-1003
  20. Chiou YY, Wang ST, Tang MJ, Lee BF, Chiu NT. Renal fibrosis: prediction from acute pyelonephritis focus volume measured at 99mTc dimercaptosuccinic acid SPECT. Radiology 2001;221:366-70. https://doi.org/10.1148/radiol.2212010146
  21. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011;365:239-50. https://doi.org/10.1056/NEJMra1007755
  22. Blane CE, DiPietro MA, Zerin JM, Sedman AB, Bloom DA. Renal sonography is not a reliable screening examination for vesicoureteral reflux. J Urol 1993;150(2 Pt 2):752-5. https://doi.org/10.1016/S0022-5347(17)35605-7
  23. Rice DC, Majd M, Rushton HG. Renal imaging: infection. In: Palmer LS, Palmer JS, editors. Pediatric and adolescent urologic imaging. New York: Springer, 2014:251-76.
  24. Jaksic E, Bogdanovic R, Artiko V, Saranovic DS, Petrasinovic Z, Petrovic M, et al. Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis. Ann Nucl Med 2011;25:37-43. https://doi.org/10.1007/s12149-010-0431-5
  25. Vachvanichsanong P, Dissaneewate P, McNeil E. Childhood recurrent urinary tract infection in southern Thailand. Ren Fail 2013;35:66-71. https://doi.org/10.3109/0886022X.2012.741647
  26. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007;298: 179-86. https://doi.org/10.1001/jama.298.2.179
  27. Lane MC, Mobley HL. Role of P-fimbrial-mediated adherence in pyelonephritis and persistence of uropathogenic Escherichia coli (UPEC) in the mammalian kidney. Kidney Int 2007;72:19-25. https://doi.org/10.1038/sj.ki.5002230
  28. Linshaw MA. Controversies in childhood urinary tract infections. World J Urol 1999;17:383-95. https://doi.org/10.1007/s003450050164
  29. Lin KY, Chiu NT, Chen MJ, Lai CH, Huang JJ, Wang YT, et al. Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol 2003;18:362-5.
  30. Han SB, Ko YM, Lee SY, Jeong DC, Kang JH, Lee KY, et al. The significance of (99m)technetium dimercaptosuccinic acid (DMSA) scan as a substitute for voiding cystourethrography (VCUG) in evaluating children with first febrile urinary tract infection. J Korean Soc Pediatr Nephrol 2007;11:220-8. https://doi.org/10.3339/jkspn.2007.11.2.220
  31. Marks SD, Gordon I, Tullus K. Imaging in childhood urinary tract infections: time to reduce investigations. Pediatr Nephrol 2008;23:9-17.
  32. Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013;25:88-94. https://doi.org/10.1097/MOP.0b013e32835c14cc

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