Egyptian pediatric clinical practice guidelines for urinary tract infections in infants and children (evidence based)

• Published in: The Gazette of the Egyptian Paediatric Association 2021-12, Vol.69 (1), p.1-12, Article 43
• Main Authors: Moustafa, Bahia H., Rabie, Moftah M., El Hakim, Ihab Z., Badr, Ahmed, El Balshy, Moustafa, Kamal, Nesreen Mohamad, Ali, Ragia Marei
• Format: Article
• Language: English
• Subjects: Abdomen; Antibiotics; Asia; Associations, institutions, etc; Clinical medicine; Clinical practice guidelines; Diagnosis; Diseases; Egypt; Evidence based; Evidence-based medicine; Family physicians; Fever; Guidelines; Hematuria; Infants; Infants and children; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Pediatric urology; Pediatrics; Physicians; Practice guidelines (Medicine); Risk factors; Societies; Systematic review; Urinary tract diseases; Urinary tract infections; Urine; Urogenital system; Urology
• ISSN: 2090-9942; 1110-6638; 2090-9942
• DOI: 10.1186/s43054-021-00073-z

Background National evidence-based recommendations for diagnosis, treatment, imaging, and follow-up in urinary tract infection are crucial being a major health problem in pediatrics. Every region should follow international recommendations with respect to the disease local profile and available facilities for that area. Methods Based on AGREE II (the assessment tool of practice guidelines), Egyptian CGLs used *American Academy Pediatrics, *European Association Urology, European Society Pediatric Urology, and *Asian Association Urinary tract infections as its evidence-based references. Health questions were listed for evidence base answers adopted from selected CGLs after their permission. Key statements were approved by all members and further approved by the Egyptian Pediatric Guidelines Committee after local and international external peer reviewing. Results (1) Diagnosis recommendations: Urine culture with diagnostic colony counts is essential for diagnosis. Catheter samples are important for critical cases and non-toilet-trained cases especially when they show significant bacteriuria and pyuria. (2) Treatment plan included areas of debate as choice of antibiotic, oral versus intravenous, duration, antibiotic prophylaxis considering age, disease severity, recurrence, + risk factors, and imaging reports. (3) Imaging recommendations were tailored to suit our community. Renal bladder ultrasound is important for children with febrile UTI, due to the high prevalence of congenital anomalies of the kidney and urinary tract, paucity of prenatal ultrasound, and lack of medical documentation to reflect previously diagnosed UTI or US reports. We recommend renal isotopic scan and voiding cystography for serious presentation, high-risk factors, recurrence, and abnormal US. (4) Urological consultation is recommended: in urosepsis or obstruction, male infants < 6 months. Acute basal DMSA is recommended in congenital renal hypodysplasia. Six months post-infection, US and DMSA are recommended in severe pyelonephritis and vesico-ureteric reflux, where those with abnormal US or DMSA or both should have voiding cystography. (5) Follow-up recommendations include family orientation with hazards of noncompliance and monitoring at pregnancy. Conclusion Diagnosis and treatment show strong recommendations. Imaging depends on patient assessment. Referral to a pediatric nephrologist and urologist in complicated cases is crucial. Follow-up after the age of 16 years in adult clinics