Skip to main content

Urinary Tract Infections in Children

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Pediatric Nephrology

Abstract

Urinary tract infection (UTI) remains among the most common bacterial infections in childhood. An association between UTIs and abnormalities of the renal tract, particularly vesicoureteral reflux, has long been recognized. Concern that episodes of pyelonephritis might result in significant damage to the kidneys culminating in chronic kidney disease (CKD) or even end-stage kidney disease has been tempered in recent times; moreover, any existing CKD is now recognized as predominantly congenital in origin. Recurrent infections, particularly febrile UTIs, do still however have accompanying morbidity. This chapter will address all aspects of childhood and adolescent UTI with particular emphasis on our current understanding of the pathophysiology, diagnosis, and management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Hellstrom A, Hanson E, Hansson S, Hjalmas K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child. 1991;66(2):232–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653–60.

    Article  PubMed  Google Scholar 

  3. Bailey RR. The relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis-reflux nephropathy. Clin Nephrol. 1973;1(3):132–41.

    PubMed  CAS  Google Scholar 

  4. International Reflux Study Committee. Medical versus surgical treatment of primary vesicoureteral reflux: report of the international reflux study committee. Pediatrics. 1981;67(3):392–400.

    Article  Google Scholar 

  5. Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux: two years’ observation in 96 children. Br Med J (Clin Res Ed). 1983;287(6386):171–4.

    Google Scholar 

  6. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med. 2011;365(3):239–50.

    Article  PubMed  CAS  Google Scholar 

  7. Thomson J, Cruz AT, Nigrovic LE, Freedman SB, Garro AC, Ishimine PT, et al. Concomitant bacterial meningitis in infants with urinary tract infection. Pediatr Infect Dis J. 2017;36(9):908–10.

    Article  PubMed  Google Scholar 

  8. Nugent J, Childers M, Singh-Miller N, Howard R, Allard R, Eberly M. Risk of meningitis in infants aged 29 to 90 days with urinary tract infection: a systematic review and meta-analysis. J Pediatr. 2019;212:102–10. e5

    Article  PubMed  Google Scholar 

  9. Becknell B, Schober M, Korbel L, Spencer JD. The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections. Expert Rev Anti-Infect Ther. 2015;13(1):81–90.

    Article  PubMed  CAS  Google Scholar 

  10. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health. 2017;37(4):273–9.

    Article  PubMed  Google Scholar 

  11. Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary tract infection in children. Recent Patents Inflamm Allergy Drug Discov. 2019;13(1):2–18.

    Article  CAS  Google Scholar 

  12. Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol. 2013;190(1):222–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Sobel JD, Vazquez JA. Fungal infections of the urinary tract. World J Urol. 1999;17(6):410–4.

    Article  PubMed  CAS  Google Scholar 

  14. Barber AE, Norton JP, Wiles TJ, Mulvey MA. Strengths and limitations of model Systems for the Study of urinary tract infections and related pathologies. Microbiol Mol Biol Rev. 2016;80(2):351–67.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Becknell B, Schwaderer A, Hains DS, Spencer JD. Amplifying renal immunity: the role of antimicrobial peptides in pyelonephritis. Nat Rev Nephrol. 2015;11(11):642–55.

    Article  PubMed  CAS  Google Scholar 

  16. Martinez JJ, Mulvey MA, Schilling JD, Pinkner JS, Hultgren SJ. Type 1 pilus-mediated bacterial invasion of bladder epithelial cells. EMBO J. 2000;19(12):2803–12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Mulvey MA, Schilling JD, Martinez JJ, Hultgren SJ. Bad bugs and beleaguered bladders: interplay between uropathogenic Escherichia coli and innate host defenses. Proc Natl Acad Sci U S A. 2000;97(16):8829–35.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Justice SS, Hung C, Theriot JA, Fletcher DA, Anderson GG, Footer MJ, et al. Differentiation and developmental pathways of uropathogenic Escherichia coli in urinary tract pathogenesis. Proc Natl Acad Sci U S A. 2004;101(5):1333–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Dalghi MG, Montalbetti N, Carattino MD, Apodaca G. The Urothelium: life in a liquid environment. Physiol Rev. 2020;100(4):1621–705.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rosen DA, Hooton TM, Stamm WE, Humphrey PA, Hultgren SJ. Detection of intracellular bacterial communities in human urinary tract infection. PLoS Med. 2007;4(12):e329.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mysorekar IU, Hultgren SJ. Mechanisms of uropathogenic Escherichia coli persistence and eradication from the urinary tract. Proc Natl Acad Sci U S A. 2006;103(38):14170–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Mulvey MA, Schilling JD, Hultgren SJ. Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection. Infect Immun. 2001;69(7):4572–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Pichon C, Hechard C, du Merle L, Chaudray C, Bonne I, Guadagnini S, et al. Uropathogenic Escherichia coli AL511 requires flagellum to enter renal collecting duct cells. Cell Microbiol. 2009;11(4):616–28.

    Article  PubMed  CAS  Google Scholar 

  24. Bens M, Vimont S, Ben Mkaddem S, Chassin C, Goujon JM, Balloy V, et al. Flagellin/TLR5 signalling activates renal collecting duct cells and facilitates invasion and cellular translocation of uropathogenic Escherichia coli. Cell Microbiol. 2014;16(10):1503–17.

    Article  PubMed  CAS  Google Scholar 

  25. Chassin C, Goujon JM, Darche S, du Merle L, Bens M, Cluzeaud F, et al. Renal collecting duct epithelial cells react to pyelonephritis-associated Escherichia coli by activating distinct TLR4-dependent and -independent inflammatory pathways. J Immunol. 2006;177(7):4773–84.

    Article  PubMed  CAS  Google Scholar 

  26. Chassin C, Tourneur E, Bens M, Vandewalle A. A role for collecting duct epithelial cells in renal antibacterial defences. Cell Microbiol. 2011;13(8):1107–13.

    Article  PubMed  CAS  Google Scholar 

  27. Paragas N, Kulkarni R, Werth M, Schmidt-Ott KM, Forster C, Deng R, et al. Alpha-intercalated cells defend the urinary system from bacterial infection. J Clin Invest. 2014;124(7):2963–76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Roberts JA, Marklund BI, Ilver D, Haslam D, Kaack MB, Baskin G, et al. The Gal(alpha 1-4)Gal-specific tip adhesin of Escherichia coli P-fimbriae is needed for pyelonephritis to occur in the normal urinary tract. Proc Natl Acad Sci U S A. 1994;91(25):11889–93.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Chassin C, Vimont S, Cluzeaud F, Bens M, Goujon JM, Fernandez B, et al. TLR4 facilitates translocation of bacteria across renal collecting duct cells. J Am Soc Nephrol. 2008;19(12):2364–74.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Spencer JD, Schwaderer AL, Becknell B, Watson J, Hains DS. The innate immune response during urinary tract infection and pyelonephritis. Pediatr Nephrol. 2014;29(7):1139–49.

    Article  PubMed  Google Scholar 

  31. Zasloff M. Antimicrobial peptides, innate immunity, and the normally sterile urinary tract. J Am Soc Nephrol. 2007;18(11):2810–6.

    Article  PubMed  CAS  Google Scholar 

  32. Ching C, Schwartz L, Spencer JD, Becknell B. Innate immunity and urinary tract infection. Pediatr Nephrol. 2019;29:1139–49.

    Google Scholar 

  33. Lacerda Mariano L, Ingersoll MA. The immune response to infection in the bladder. Nat Rev Urol. 2020;17(8):439–58.

    Article  PubMed  Google Scholar 

  34. Li B, Haridas B, Jackson AR, Cortado H, Mayne N, Kohnken R, et al. Inflammation drives renal scarring in experimental pyelonephritis. Am J Physiol Renal Physiol. 2017;312(1):F43–53.

    Article  PubMed  CAS  Google Scholar 

  35. Park YS. Renal scar formation after urinary tract infection in children. Korean J Pediatr. 2012;55(10):367–70.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Humphreys BD. Mechanisms of renal fibrosis. Annu Rev Physiol. 2018;80:309–26.

    Article  PubMed  CAS  Google Scholar 

  37. Murugapoopathy V, McCusker C, Gupta IR. The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis. Pediatr Nephrol. 2020;35(3):349–57.

    Article  PubMed  Google Scholar 

  38. Oxburgh L, de Caestecker MP. Ischemia-reperfusion injury of the mouse kidney. Methods Mol Biol. 2012;886:363–79.

    Article  PubMed  CAS  Google Scholar 

  39. Chevalier RL, Forbes MS, Thornhill BA. Ureteral obstruction as a model of renal interstitial fibrosis and obstructive nephropathy. Kidney Int. 2009;75(11):1145–52.

    Article  PubMed  Google Scholar 

  40. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28(1):255–77. quiz 327-8

    Article  PubMed  Google Scholar 

  41. Demertzis J, Menias CO. State of the art: imaging of renal infections. Emerg Radiol. 2007;14(1):13–22.

    Article  PubMed  Google Scholar 

  42. Kass EH. Bacteriuria and pyelonephritis of pregnancy. Arch Intern Med. 1960;105:194–8.

    Article  PubMed  CAS  Google Scholar 

  43. Swerkersson S, Jodal U, Ahren C, Sixt R, Stokland E, Hansson S. Urinary tract infection in infants: the significance of low bacterial count. Pediatr Nephrol. 2016;31(2):239–45.

    Article  PubMed  Google Scholar 

  44. Tullus K. Low urinary bacterial counts: do they count? Pediatr Nephrol. 2016;31(2):171–4.

    Article  PubMed  Google Scholar 

  45. Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, et al. The diagnosis of urinary tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess. 2016;20(51):1–294.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Subcommittee on Urinary Tract Infection SCoQI, Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595–610.

    Article  Google Scholar 

  47. Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, et al. Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children. Acta Paediatr. 2020;109(2):236–47.

    Article  PubMed  Google Scholar 

  48. Herreros Fernandez ML, Gonzalez Merino N, Tagarro Garcia A, Perez Seoane B, de la Serna Martinez M, Contreras Abad MT, et al. A new technique for fast and safe collection of urine in newborns. Arch Dis Child. 2013;98(1):27–9.

    Article  PubMed  Google Scholar 

  49. Kennedy KM, Glynn LG, Dineen B. A survey of the management of urinary tract infection in children in primary care and comparison with the NICE guidelines. BMC Fam Pract. 2010;11:6.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Al-Orifi F, McGillivray D, Tange S, Kramer MS. Urine culture from bag specimens in young children: are the risks too high? J Pediatr. 2000;137(2):221–6.

    Article  PubMed  CAS  Google Scholar 

  51. Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, et al. Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics. 2013;131(5):870–9.

    Article  PubMed  Google Scholar 

  52. Shaikh N, Martin JM, Hoberman A, Skae M, Milkovich L, Nowalk A, et al. Host and bacterial markers that differ in children with cystitis and pyelonephritis. J Pediatr. 2019;209:146–53. e1

    Article  PubMed  PubMed Central  Google Scholar 

  53. Preda I, Jodal U, Sixt R, Stokland E, Hansson S. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr. 2007;151(6):581–4. 4 e1

    Article  PubMed  Google Scholar 

  54. Hansson S, Dhamey M, Sigstrom O, Sixt R, Stokland E, Wennerstrom M, et al. Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol. 2004;172(3):1071–3. discussion 3-4

    Article  PubMed  Google Scholar 

  55. Thomson J, Mc Donald S. On acute pyelitis due to bacillus coli as it occurs in infancy. QJM. 2010;3:251–68.

    Google Scholar 

  56. Fitzgerald A, Mori R, Lakhanpaul M, Tullus K. Antibiotics for treating lower urinary tract infection in children. Cochrane Database Syst Rev. 2012;8:CD006857.

    Google Scholar 

  57. Francois P, Croize J, Bost C, Wollschlager K. Comparative study of cefixime versus amoxicillin-clavulanic acid combination in the oral treatment of urinary tract infections in children. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie. 1995;2(2):136–42.

    CAS  Google Scholar 

  58. Benador D, Neuhaus TJ, Papazyan JP, Willi UV, Engel-Bicik I, Nadal D, et al. Randomised controlled trial of three day versus 10 day intravenous antibiotics in acute pyelonephritis: effect on renal scarring. Arch Dis Child. 2001;84(3):241–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Levtchenko E, Lahy C, Levy J, Ham H, Piepsz A. Treatment of children with acute pyelonephritis: a prospective randomized study. Pediatr Nephrol. 2001;16(11):878–84.

    Article  PubMed  CAS  Google Scholar 

  60. Vilaichone A, Watana D, Chaiwatanarat T. Oral ceftibuten switch therapy for acute pyelonephritis in children. J Medl Assoc Thail = Chotmaihet thangphaet. 2001;84(Suppl 1):S61–7.

    Google Scholar 

  61. Noorbakhsh S, Lari AR, Masjedian F, Mostafavi H, Alaghehbandan R. Comparison of intravenous aminoglycoside therapy with switch therapy to cefixime in urinary tract infections. Saudi Med J. 2004;25(10):1513–5.

    PubMed  Google Scholar 

  62. Montini G, Toffolo A, Zucchetta P, Dall’Amico R, Gobber D, Calderan A, et al. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. BMJ. 2007;335(7616):386.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics. 1999;104(1 Pt 1):79–86.

    Article  PubMed  CAS  Google Scholar 

  64. Bocquet N, Sergent Alaoui A, Jais JP, Gajdos V, Guigonis V, Lacour B, et al. Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics. 2012;129(2):e269–75.

    Article  PubMed  Google Scholar 

  65. Neuhaus TJ, Berger C, Buechner K, Parvex P, Bischoff G, Goetschel P, et al. Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis. Eur J Pediatr. 2008;167(9):1037–47.

    Article  PubMed  CAS  Google Scholar 

  66. Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr. 2012;101(5):451–7.

    Article  PubMed  Google Scholar 

  67. Sorensen OE, Thapa DR, Roupe KM, Valore EV, Sjobring U, Roberts AA, et al. Injury-induced innate immune response in human skin mediated by transactivation of the epidermal growth factor receptor. J Clin Invest. 2006;116(7):1878–85.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  68. Delbet JD, Lorrot M, Ulinski T. An update on new antibiotic prophylaxis and treatment for urinary tract infections in children. Expert Opin Pharmacother. 2017;18(15):1619–25.

    Article  PubMed  CAS  Google Scholar 

  69. Nelson CP, Hoberman A, Shaikh N, Keren R, Mathews R, Greenfield SP, et al. Antimicrobial resistance and urinary tract infection recurrence. Pediatrics. 2016;137(4):e20152490.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Hogan J, Dourthe ME, Blondiaux E, Jouannic JM, Garel C, Ulinski T. Renal outcome in children with antenatal diagnosis of severe CAKUT. Pediatr Nephrol. 2012;27(3):497–502.

    Article  PubMed  Google Scholar 

  71. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348(3):195–202.

    Article  PubMed  Google Scholar 

  72. Zamir G, Sakran W, Horowitz Y, Koren A, Miron D. Urinary tract infection: is there a need for routine renal ultrasonography? Arch Dis Child. 2004;89(5):466–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  73. Montini G, Zucchetta P, Tomasi L, Talenti E, Rigamonti W, Picco G, et al. Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1. Pediatrics. 2009;123(2):e239–46.

    Article  PubMed  Google Scholar 

  74. McTaggart S, Danchin M, Ditchfield M, Hewitt I, Kausman J, Kennedy S, et al. KHA-CARI guideline: diagnosis and treatment of urinary tract infection in children. Nephrology (Carlton). 2015;20(2):55–60.

    Article  Google Scholar 

  75. Wan J, Skoog SJ, Hulbert WC, Casale AJ, Greenfield SP, Cheng EY, et al. Section on urology response to new guidelines for the diagnosis and management of UTI. Pediatrics. 2012;129(4):e1051–3.

    Article  PubMed  Google Scholar 

  76. Rensing A, Austin P. The diagnosis and treatment of vesicoureteral reflux: an update. Open J Urol Nephrol. 2015;8(suppl 3:M3):96–103.

    Article  Google Scholar 

  77. Hewitt IK, Montini G. Re-evaluating the use of ultrasound to investigate first febrile urinary tract infections in childhood. Acta Paediatr. 2017;106(11):1727–8.

    Article  PubMed  Google Scholar 

  78. Stein R, Dogan HS, Hoebeke P, Kocvara R, Nijman RJ, Radmayr C, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 2015;67(3):546–58.

    Article  PubMed  Google Scholar 

  79. Wennerstrom M, Hansson S, Jodal U, Stokland E. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr. 2000;136(1):30–4.

    Article  PubMed  CAS  Google Scholar 

  80. Broyer M, Chantler C, Donckerwolcke R, Ehrich JH, Rizzoni G, Scharer K. The paediatric registry of the European Dialysis and transplant association: 20 years’ experience. Pediatr Nephrol. 1993;7(6):758–68.

    Article  PubMed  CAS  Google Scholar 

  81. Brandstrom P, Neveus T, Sixt R, Stokland E, Jodal U, Hansson S. The Swedish reflux trial in children: IV. Renal damage. J Urol. 2010;184(1):292–7.

    Article  PubMed  Google Scholar 

  82. Gordon ZN, McLeod DJ, Becknell B, Bates DG, Alpert SA. Uroepithelial thickening on sonography improves detection of vesicoureteral reflux in children with first febrile urinary tract infection. J Urol. 2015;194(4):1074–9.

    Article  PubMed  Google Scholar 

  83. Alberici I, La Manna A, Pennesi M, Starc M, Scozzola F, Nicolini G, et al. First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. Acta Paediatr. 2019;108(3):544–50.

    Article  PubMed  CAS  Google Scholar 

  84. Fouzas S, Krikelli E, Vassilakos P, Gkentzi D, Papanastasiou DA, Salakos C. DMSA scan for revealing vesicoureteral reflux in young children with urinary tract infection. Pediatrics. 2010;126(3):e513–9.

    Article  PubMed  Google Scholar 

  85. Marks SD, Gordon I, Tullus K. Imaging in childhood urinary tract infections: time to reduce investigations. Pediatr Nephrol. 2008;23(1):9–17.

    Article  PubMed  Google Scholar 

  86. Capone V, Taroni F, Pavesi MA, Castellani M, Consonni D, Berrettini A, et al. Voiding cystourethrography and (99M)TC-MAG3 renal scintigraphy in pediatric vesicoureteral reflux: what is the role of indirect cystography? J Pediatr Urol. 2019;15(5):514. e1- e6

    Article  PubMed  Google Scholar 

  87. Jones RA, Grattan-Smith JD, Little S. Pediatric magnetic resonance urography. J Magn Reson imaging: JMRI. 2011;33(3):510–26.

    Article  PubMed  Google Scholar 

  88. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on quality improvement. Subcommittee on urinary tract infection. Pediatrics. 1999;103(4 Pt 1):843–52.

    Google Scholar 

  89. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006;117(3):626–32.

    Article  PubMed  Google Scholar 

  90. Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008;121(6):e1489–94.

    Article  PubMed  Google Scholar 

  91. Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008;179(2):674–9. discussion 9

    Article  PubMed  CAS  Google Scholar 

  92. Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008;122(5):1064–71.

    Article  PubMed  Google Scholar 

  93. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009;361(18):1748–59.

    Article  PubMed  CAS  Google Scholar 

  94. Brandstrom P, Esbjorner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010;184(1):286–91.

    Article  PubMed  Google Scholar 

  95. Investigators RT, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370(25):2367–76.

    Article  Google Scholar 

  96. Hari P, Hari S, Sinha A, Kumar R, Kapil A, Pandey RM, et al. Antibiotic prophylaxis in the management of vesicoureteric reflux: a randomized double-blind placebo-controlled trial. Pediatr Nephrol. 2015;30(3):479–86.

    Article  PubMed  Google Scholar 

  97. Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2019;4:CD001534.

    PubMed  Google Scholar 

  98. Hewitt IK, Pennesi M, Morello W, Ronfani L, Montini G. Antibiotic prophylaxis for urinary tract infection-related renal scarring: a systematic review. Pediatrics. 2017;139(5):e20163145.

    Article  PubMed  Google Scholar 

  99. Clarke SA, Samuel M, Boddy SA. Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. J Pediatr Surg. 2005;40(3):568–71.

    Article  PubMed  Google Scholar 

  100. Morton SC, Shekelle PG, Adams JL, Bennett C, Dobkin BH, Montgomerie J, et al. Antimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction. Arch Phys Med Rehabil. 2002;83(1):129–38.

    Article  PubMed  Google Scholar 

  101. Schlager TA, Johnson JR, Ouellette LM, Whittam TS. Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function. Spinal Cord. 2008;46(9):633–8.

    Article  PubMed  CAS  Google Scholar 

  102. Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database Syst Rev. 2012;11:CD009129.

    PubMed  Google Scholar 

  103. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005;90(8):853–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  104. Morris BJ, Wiswell TE. Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis. J Urol. 2013;189(6):2118–24.

    Article  PubMed  Google Scholar 

  105. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.

    PubMed  Google Scholar 

  106. Stapleton AE, Au-Yeung M, Hooton TM, Fredricks DN, Roberts PL, Czaja CA, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis. 2011;52(10):1212–7.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Lee SJ, Cha J, Lee JW. Probiotics prophylaxis in pyelonephritis infants with normal urinary tracts. World J Pediatr. 2016;12(4):425–9.

    Article  PubMed  CAS  Google Scholar 

  108. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997;100(2 Pt 1):228–32.

    Article  PubMed  CAS  Google Scholar 

  109. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084–91.

    Article  PubMed  Google Scholar 

  110. Hewitt IK, Zucchetta P, Rigon L, Maschio F, Molinari PP, Tomasi L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian renal infection study trials. Pediatrics. 2008;122(3):486–90.

    Article  PubMed  Google Scholar 

  111. Shaikh N, Craig JC, Rovers MM, Da Dalt L, Gardikis S, Hoberman A, et al. Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatr. 2014;168(10):893–900.

    Article  PubMed  Google Scholar 

  112. Toffolo A, Ammenti A, Montini G. Long-term clinical consequences of urinary tract infections during childhood: a review. Acta Paediatr. 2012;101(10):1018–31.

    Article  PubMed  Google Scholar 

  113. Jansen H, Scholtmeijer RJ. Results of surgical treatment of severe vesicoureteric reflux. Retrospective study of reflux grades 4 and 5. Br J Urol. 1990;65(4):413–7.

    Article  PubMed  CAS  Google Scholar 

  114. Weiss R, Duckett J, Spitzer A. Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The international reflux study in children. J Urol. 1992;148(5 Pt 2):1667–73.

    Article  PubMed  CAS  Google Scholar 

  115. Smellie JM, Prescod NP, Shaw PJ, Risdon RA, Bryant TN. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults. Pediatr Nephrol. 1998;12(9):727–36.

    Article  PubMed  CAS  Google Scholar 

  116. Smellie JM, Barratt TM, Chantler C, Gordon I, Prescod NP, Ransley PG, et al. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet. 2001;357(9265):1329–33.

    Article  PubMed  CAS  Google Scholar 

  117. Jodal U, Smellie JM, Lax H, Hoyer PF. Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the international reflux study in children. Pediatr Nephrol. 2006;21(6):785–92.

    Article  PubMed  Google Scholar 

  118. Wennerstrom M, Hansson S, Jodal U, Sixt R, Stokland E. Renal function 16 to 26 years after the first urinary tract infection in childhood. Arch Pediatr Adolesc Med. 2000;154(4):339–45.

    Article  PubMed  CAS  Google Scholar 

  119. Geback C, Hansson S, Martinell J, Milsom I, Sandberg T, Jodal U. Obstetrical outcome in women with urinary tract infections in childhood. Acta Obstet Gynecol Scand. 2016;95(4):452–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Montini .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer-Verlag GmbH Germany, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Montini, G., Spencer, J.D., Hewitt, I.K. (2021). Urinary Tract Infections in Children. In: Emma, F., Goldstein, S., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27843-3_49-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-27843-3_49-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27843-3

  • Online ISBN: 978-3-642-27843-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Urinary Tract Infections in Children
    Published:
    04 December 2021

    DOI: https://doi.org/10.1007/978-3-642-27843-3_49-2

  2. Original

    Urinary Tract Infections in Children
    Published:
    03 December 2014

    DOI: https://doi.org/10.1007/978-3-642-27843-3_49-1