Updated Italian recommendations for the diagnosis, treatment and follow‐up of the first febrile urinary tract infection in young children

Ammenti, Anita; Alberici, Irene; Brugnara, Milena; Chimenz, Roberto; Guarino, Stefano; Manna, Angela La; Scola, Claudio La; Maringhini, Silvio; Marra, Giuseppina; Materassi, Marco; Morello, William; Nicolini, Giangiacomo; Pennesi, Marco; Pisanello, Lorena; Pugliese, Fabrizio; Scozzola, Floriana; Sica, Felice; Toffolo, Antonella; Montini, Giovanni

doi:10.1111/apa.14988

Cited by 92 publications

(144 citation statements)

References 93 publications

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“…Other international guidelines from Australia, Canada, the European Society for Paediatric Urology, Israel, Italy and New Zealand suggest the use of bag sampling in systemically well children, with an alternate method of collection required (clean catch, catheter or SPA) if dipstick from bag samples is suggestive of infection [13][14][15][16][17][18].…”

Section: Key Guidancementioning

confidence: 99%

Urine collection methods and dipstick testing in non-toilet-trained children

Diviney

Jaswon

2020

Pediatr Nephrol

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Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and definitive diagnosis requires an uncontaminated urine sample to be obtained. Common techniques for sampling in non-toilet-trained children include clean catch, bag, pad, in-out catheterisation and suprapubic aspiration. The pros and cons of each method are examined in detail in this review. They differ significantly in frequency of use, contamination rates and acceptability to parents and clinicians. National guidance of which to use differs significantly internationally. No method is clearly superior. For non-invasive testing, clean catch sampling has a lower likelihood of contamination and can be made more efficient through stimulation of voiding in younger children. In invasive testing, suprapubic aspiration gives a lower likelihood of contamination, a high success rate and a low complication rate, but is considered painful and is not preferred by parents. Urine dipstick testing is validated for ruling in or out UTI provided that leucocyte esterase (LE) and nitrite testing are used in combination.

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Section: Key Guidancementioning

confidence: 99%

Urine collection methods and dipstick testing in non-toilet-trained children

Diviney

Jaswon

2020

Pediatr Nephrol

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“… 23 , 24 Several recent guidelines recommend voiding stimulation techniques, such as the Quick-Wee method, to improve the speed and success of clean catch collection. 7 , 28 – 30 …”

Section: Discussionmentioning

confidence: 99%

What’s the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care.

2020

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BackgroundUrinary tract infections (UTIs) are common in young pre-continent children, but collecting urine samples is challenging. Collection methods all have limitations and international guidelines have conflicting recommendations. Choice of method must balance time, resources, invasiveness, reliability, and contamination. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods.AimTo understand the barriers and enablers to collecting urine samples from young pre-continent children in primary care.Design & settingAn exploratory qualitative study performed in primary care in Australia.MethodSemi-structured interviews explored the topic of collecting a urine sample from a child aged 6 months who presented with a fever. The interviews were undertaken with 21 GPs and four practice nurses (PNs) until data saturation was reached. Interviews were audiorecorded, transcribed verbatim, coded, and underwent content and thematic analysis.ResultsFive main themes emerged including: the clinician’s knowledge and expertise; patient characteristics; parent or carer’s understanding and motivation; the collection process itself; and likely outcome of the chosen method. Non-invasive methods were strongly favoured; although, clean catch was considered time-consuming and urine bags were known to be often contaminated. Invasive methods (for example, catheterisation or suprapubic aspiration [SPA]) were rarely performed outside of remote settings. Key barriers included time and space constraints in clinics, and key enablers included parental motivation, education handouts, and voiding stimulation methods.ConclusionThis study has identified key barriers and enablers to inform education, policy, and future research for urine sample collection from pre-continent children in primary care. Guideline recommendations must consider the primary care context to ensure they are relevant and suited to real-world practice.

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“…Clinicians often felt that determination of blood tests, although part of local management protocols, was timeconsuming and was of limited added value in well-appearing previously healthy children with a first uncomplicated UTI episode. The role and yield of blood markers in the management of first febrile UTIs episodes are debatable and are not routinely recommended by the Italian guidelines, the National Institute of Care Excellence (NICE), and the American Academy of Pediatrics (AAP) guidelines [3,[26][27][28][29]. While there is general agreement that blood tests should be performed in infants younger than 2 or 3 months, our study included only children older than 2 months.…”

Section: Discussionmentioning

confidence: 99%

Oral steroids for reducing kidney scarring in young children with febrile urinary tract infections: the contribution of Bayesian analysis to a randomized trial not reaching its intended sample size

et al. 2021

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Background This study aimed to evaluate the effect of oral dexamethasone in reducing kidney scars in infants with a first febrile urinary tract infection (UTI). Methods Children aged between 2 and 24 months with their first presumed UTI, at high risk for kidney scarring based on procalcitonin levels (≥1 ng/mL), were randomly assigned to receive dexamethasone in addition to routine care or routine care only. Kidney scars were identified by kidney scan at 6 months after initial UTI. Projections of enrollment and follow-up completion showed that the intended sample size could not be reached before funding and time to complete the study ran out. An amendment to the protocol was approved to conduct a Bayesian analysis. Results We randomized 48 children, of whom 42 had a UTI and 18 had outcome kidney scans (instead of 128 planned). Kidney scars were found in 0/7 and 2/11 patients in the treatment and control groups respectively. The probability that dexamethasone could prevent kidney scarring was 99% in the setting of an informative prior probability distribution (which fully incorporated in the final inference the information on treatment effect provided by previous studies) and 98% in the low-informative scenario (which discounted the prior literature information by 50%). The probabilities that dexamethasone could reduce kidney scar formation by up to 20% were 61% and 53% in the informative and low-informative scenario, respectively. Conclusions Dexamethasone is highly likely to reduce kidney scarring, with a more than 50% probability to reduce kidney scars by up to 20%. Trial registration number EudraCT number: 2013-000388-10; registered in 2013 (prospectively registered) Graphical Abstract

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Updated Italian recommendations for the diagnosis, treatment and follow‐up of the first febrile urinary tract infection in young children

Cited by 92 publications

References 93 publications

Urine collection methods and dipstick testing in non-toilet-trained children

Urine collection methods and dipstick testing in non-toilet-trained children

What’s the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care.

Oral steroids for reducing kidney scarring in young children with febrile urinary tract infections: the contribution of Bayesian analysis to a randomized trial not reaching its intended sample size

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