urinary tract infection - Mayo Clinic
urinary tract infection - Mayo Clinic
A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower ...

The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded. The guideline is intended for use in a variety of clinical settings (eg, office, emergency department, or hospital) by clinicians who treat infants and young children. Therefore, in cases in which antimicrobial therapy will be initiated, catheterization or SPA is required to establish the diagnosis of UTI. The data on which the recommendations are based are included in a companion technical report. Data are insufficient to determine whether the evidence generated from studies of infants 2 to 24 months of age applies to children more than 24 months of age.

To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study. The guideline was reviewed by multiple groups within the AAP (7 committees, 1 council, and 9 sections) and 5 external organizations in the United States and Canada. Rather, it is intended to assist clinicians in decision-making. Role of patient preferences: There is no evidence regarding patient preferences for bag versus catheterized urine.

The latter was based on the new and growing body of evidence questioning the effectiveness of antimicrobial prophylaxis to prevent recurrent febrile UTI in children with VUR. Aggregate quality of evidence: A (diagnostic studies on relevant populations). Neonates and infants less than 2 months of age are excluded, because there are special considerations in this age group that may limit the application of evidence derived from the studies of 2- to 24-month-old children. The guideline will be reviewed and/or revised in 5 years, unless new evidence emerges that warrants revision sooner. It was developed by a subcommittee of the Steering Committee on Quality Improvement and Management that included physicians with expertise in the fields of academic general pediatrics, epidemiology and informatics, pediatric infectious diseases, pediatric nephrology, pediatric practice, pediatric radiology, and pediatric urology. Because the clinical presentation tends to be nonspecific in infants and reliable urine specimens for culture cannot be obtained without invasive methods (urethral catheterization or suprapubic aspiration [SPA]), diagnosis and treatment may be delayed. The AAP funded the development of this guideline; none of the participants had any financial conflicts of interest. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Cultures of urine specimens collected in a bag applied to the perineum have an unacceptably high false-positive rate and are valid only when they yield negative results. To provide evidence for the guideline, 2 literature searches were conducted, that is, a surveillance of Medline-listed literature over the past 10 years for significant changes since the guideline was published and a systematic review of the literature on the effectiveness of prophylactic antimicrobial therapy to prevent recurrence of febrile UTI/pyelonephritis in children with vesicoureteral reflux (VUR).



Urinary Tract Infection: Clinical Practice Guideline for the ...
Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months Urinary tract infection definition pdf 7 Catheter-associated Urinary Tract Infection (CAUTI)January 2018 7-1 Device-associated Module UTI Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract ...

Once antimicrobial therapy is initiated, the opportunity to make a definitive diagnosis is lost; multiple studies of antimicrobial therapy have shown that the urine may be rapidly sterilized. Variable success rates for obtaining urine have been reported (23%–90%). In those studies, fever was defined as temperature of at least 38. Role of patient preferences: There is no evidence regarding patient preferences for bag versus catheterized urine. Option 1 is to obtain a urine specimen through catheterization or SPA for culture and urinalysis.

Therefore, in cases in which antimicrobial therapy will be initiated, catheterization or SPA is required to establish the diagnosis of UTI. For febrile boys, with a prevalence of UTI of 2%, the rate of false-positive results is 95%; for circumcised boys, with a prevalence of UTI of 0. SPA has been considered the standard method for obtaining urine that is uncontaminated by perineal flora. Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The latter was based on the new and growing body of evidence questioning the effectiveness of antimicrobial prophylaxis to prevent recurrent febrile UTI in children with VUR.

If a clinician assesses a febrile infant with no apparent source for the fever as not being so ill as to require immediate antimicrobial therapy, then the clinician should assess the likelihood of UTI (see below for how to assess likelihood). To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. Option 2 is to obtain a urine specimen through the most convenient means and to perform a urinalysis. This clinical practice guideline is a revision of the practice parameter published by the American Academy of Pediatrics (AAP) in 1999. Therefore, it is important to have the most-accurate test for UTI performed initially. VCUG should also be performed if there is a recurrence of a febrile UTI. The quality of evidence supporting each recommendation and the strength of the recommendation were assessed by the committee member most experienced in informatics and epidemiology and were graded according to AAP policy The subcommittee formulated 7 recommendations, which are presented in the text in the order in which a clinician would use them when evaluating and treating a febrile infant, as well as in algorithm form in the Appendix. With the introduction of effective conjugate vaccines against (which have resulted in dramatic decreases in bacteremia and meningitis), there has been increasing appreciation of the urinary tract as the most frequent site of occult and serious bacterial infections. To provide evidence for the guideline, 2 literature searches were conducted, that is, a surveillance of Medline-listed literature over the past 10 years for significant changes since the guideline was published and a systematic review of the literature on the effectiveness of prophylactic antimicrobial therapy to prevent recurrence of febrile UTI/pyelonephritis in children with vesicoureteral reflux (VUR). Like the 1999 practice parameter, this revision focuses on the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children (2–24 months of age) who have no obvious neurologic or anatomic abnormalities known to be associated with recurrent UTI or renal damage.