Child Kidney Dis.  2015 Oct;19(2):56-64. 10.3339/chikd.2015.19.2.56.

Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)

• Lee SJ

• KMID: 2168403
• DOI: http://doi.org/10.3339/chikd.2015.19.2.56

Abstract

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. 99mTc-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

Keyword

Recognition; Diagnosis; Treatment; Imaging studies; Prevention

MeSH Terms

Anti-Bacterial Agents
Catheters
Child
Cicatrix
Constipation
Diagnosis
Female
Follow-Up Studies
Humans
Hygiene
Milk, Human
Nephrology
Phimosis
Probiotics
Pyelonephritis
Technetium Tc 99m Dimercaptosuccinic Acid
Toilet Training
Ultrasonography
Urinalysis
Urinary Tract Infections*
Urinary Tract*
Vaccinium macrocarpon
Vesico-Ureteral Reflux
Anti-Bacterial Agents
Technetium Tc 99m Dimercaptosuccinic Acid