Pediatric urinary tract infection (NICE guideline)

Last revised by Mostafa Elfeky on 13 Aug 2023

Citation, DOI, disclosures and article data

Citation:

Di Muzio B, Elfeky M, Sharma R, et al. Pediatric urinary tract infection (NICE guideline). Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-48065

DOI:

https://doi.org/10.53347/rID-48065

Permalink:

https://radiopaedia.org/articles/48065

rID:

48065

Article created:

18 Sep 2016, Bruno Di Muzio ◉ ◈

Disclosures:

At the time the article was created Bruno Di Muzio had no recorded disclosures.

View Bruno Di Muzio's current disclosures

Last revised:

13 Aug 2023, Mostafa Elfeky ◉

Disclosures:

At the time the article was last revised Mostafa Elfeky had no financial relationships to ineligible companies to disclose.

View Mostafa Elfeky's current disclosures

Revisions:

9 times, by 8 contributors - see full revision history and disclosures

Systems:

Urogenital, Paediatrics

Sections:

Approach

Synonyms:

NICE guidelines for UTI
UTI in children British imaging guidelines

The British National Institute for Health and Care Excellence (NICE) published the “Urinary tract infection in under 16s: diagnosis and management” in 2007 as a guideline for pediatric urinary tract infection (UTI) management, including imaging, prophylaxis and follow-up ¹.

This article intends to summarize only the imaging approach proposed by this guideline.

atypical UTI
- seriously ill
- reduced urine flow
- abdominal or bladder mass
- increased creatinine levels
- sepsis
- failure to respond to suitable antibiotics in the first 48 hours
- infection with non-E. Coli organisms
recurrent UTI
- 2 or more episodes of UTI with acute pyelonephritis, or
- 1 episode of UTI with acute pyelonephritis and 1 or more episode of lower UTI, or
- 3 or more episodes of lower UTI

Imaging diagnosis

Clinical examination and laboratory tests are considered sufficient for UTI diagnosis, and so, routine use of imaging or this purpose is not recommended.

Management

Acute infection

Only infants and children with atypical UTI should have an ultrasound of the urinary tract during the acute infection. Imaging will help in identifying structural abnormalities of the urinary tract such as obstruction.

Follow-up

ultrasound
- infants and children who have had a lower urinary tract infection should undergo an ultrasound study within six weeks only if they are younger than 6 months, have had atypical UTI, or have had recurrent infections
DMSA
- DMSA scan 4 to 6 months following the acute onset should be considered to detect renal parenchymal defects:
  - younger than 3 years and has had an atypical or recurrent infection
  - older than 3 years and has had recurrent UTI
micturating cystourethrogram (MCUG)
- routine imaging to identify vesicoureteral reflux (VUR) is not recommended for infants and children who have had a UTI, except in particular circumstances, such as:
  - younger than 6 months and has had an atypical or recurrent infection
  - between 6-month-old and 3-year-old, only if :
    - ureteral dilatation / hydronephrosis on ultrasound
    - reduced urine flow
    - non-E. Coli infection
    - family history of VUR
- for micturating cystourethrogram (MCUG), prophylactic antibiotics should be given orally for 3 days with MCUG taking place on the second day