Table 2

Recent evidence, controversies and emerging evidence

Urine bag collectionHigh contamination rates ≈50%.15 17 Least cost-effective collection method.47 Useful for dipstick screening but unreliable for culture.
Voiding stimulation methodsImproves the speed, success and cost-effectiveness of clean catch urine collection in precontinent children16 18
Antibiotic prophylaxisNot recommended after first or second UTI in otherwise healthy children. Modest effect on recurrence, does not reduce scarring and increases antibiotic resistance.44–46
What colony counts on culture represent true UTI?Historical: 100 000 CFU/mL.30
NICE: no specific recommendation.16
AAP: 50 000 CFU/mL from catheter/SPA sample with pyuria.21
Proposed: 10 000 CFU/mL with symptoms/pyuria.29
Duration of antibiotic therapy?Short-course therapy for lower tract UTI (cystitis) may be as effective as longer courses.33
NICE: 7–10 days for pyelonephritis and 3 days for children >3 months with cystitis16
AAP: 7–14 days for all UTI.2
Choice of antibiotic agent?Must be guided by local guidelines and sensitivity patterns, as susceptibility can vary significantly between regions.21
Does uncomplicated UTI predispose to risk of chronic kidney disease?Children with structurally normal kidneys appear not at significant risk of long term renal morbidity.9 13
Imaging tests following UTI: who, what and when to image?Historical: aggressive imaging to identify VUR and scarring.
NICE: age and risk based approach.16
AAP: ultrasound for all children <2 years old with febrile UTI, VCUG if ultrasound is abnormal.21
Antibiotic resistanceIncreasing globally, highest in resource-limited settings.6 37 Increases healthcare costs.38
Urinary biomarkers to differentiate between UTI and asymptomatic bacteriuriaFor example, interleukin-6, neutrophil gelatinase-associated lipocalin: further research needed to establish clinical utility.28
Point-of-care PCR to identify presence of uropathogensCan identify common uropathogens but only specified targets so may miss uncommon bacterial species. Cannot differentiate between contamination, asymptomatic bacteriuria and infection.9
  • National Institute for Health and Care Excellence (NICE) UK Clinical Guideline 54: UTI in under 16s: diagnosis and management 2017.

  • American Association of Paediatrics Clinical Practice Guideline: the diagnosis and management of the initial UTI in febrile infants and young children 2–24 months of age 2016.

  • PCR, Polymerase Chain Reaction; SPA, suprapubic needle aspiration; UTI, urinary tract infection; VCUG, Voiding Cystourethrogram; VUR, vesicoureteric reflux.