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Pediatric Nephrology
Published in: Pediatric Nephrology 5/2024

28-10-2023 | Urinary Tract Infection | Guidelines

Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux

Authors: Pankaj Hari, Jitendra Meena, Manish Kumar, Aditi Sinha, Ranjeet W. Thergaonkar, Arpana Iyengar, Priyanka Khandelwal, Sudha Ekambaram, Priya Pais, Jyoti Sharma, Madhuri Kanitkar, Arvind Bagga, on behalf of Indian Society of Pediatric Nephrology

Published in: Pediatric Nephrology | Issue 5/2024

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Abstract

We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7–10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3–5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
Appendix
Available only for authorised users
Glossary
Acute pyelonephritis
Bacterial infection involving the upper urinary tract (kidney parenchyma)
Bacteriuria
Presence of one or more bacteria per oil immersion field in a freshly voided uncentrifuged sample
Cystitis or lower UTI
Bacterial infection localizing to the bladder
Febrile urinary tract infection
Fever (temperature ≥ 38 °C) with a positive urine culture defined by presence of significant colony count of a single uropathogen
High-grade vesicoureteric reflux
Grade 3 to 5 vesicoureteric reflux on micturating cystourethrography
Kidney scarring
Acquired kidney damage due to acute pyelonephritis
Leukocyturia
Presence of ≥ 10 leukocytes per mm3 in a fresh uncentrifuged sample, or > 5 leukocytes per high power field in a centrifuged sample
Low-grade vesicoureteric reflux
Grade 1 and 2 vesicoureteric reflux on micturating cystourethrography
Primary vesicoureteric reflux
The passage of urine from the bladder back into a ureter and kidney in the absence of obstructive uropathy and neurogenic bladder dysfunction
Recurrent urinary tract infection
Two episodes of urinary tract infection during any time period in childhood
Reflux nephropathy
Abnormalities in the renal cortex associated with primary VUR (congenital dysplasia or acquired scarring)
Renal dysplasia
Congenital abnormalities in the renal cortex due to abnormal metanephric differentiation
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Metadata
Title
Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux
Authors
Pankaj Hari
Jitendra Meena
Manish Kumar
Aditi Sinha
Ranjeet W. Thergaonkar
Arpana Iyengar
Priyanka Khandelwal
Sudha Ekambaram
Priya Pais
Jyoti Sharma
Madhuri Kanitkar
Arvind Bagga
on behalf of Indian Society of Pediatric Nephrology
Publication date
28-10-2023
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 5/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-023-06173-9

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