Written by Kimiko Dunbar
Spoon Feed
This review summarizes existing guidelines regarding management of complicated pediatric UTI and providing recommendations on testing, treatment and duration.
UTI status––it’s complicated
Up to 25% of patients presenting to the ED with a UTI have a complicated UTI (cUTI). Management of this population is tricky––there is no universal definition of cUTI and the majority of literature excludes cUTI. This European Society for Pediatric Infectious Diseases review aimed to evaluate and summarize existing guidelines on the diagnosis and management of complicated urinary tract infections (cUTIs) in children. High-points addressing the main controversies in treatment of cUTI are summarized below:
- Who gets cUTIs? Kids with anatomical or functional abnormalities, recurrent UTIs, neonates or those with underlying neurologic abnormalities, those with severe presentations (i.e. sepsis) or severe renal parenchymal disease.
- What testing is needed? Everyone, complicated or not, needs a UA (cath or clean catch) and culture. Labs and renal/bladder US may be helpful adjuncts based on the clinical situation, but aren’t needed for all.
- How to treat? Initial (empiric) antibiotic choice should include the patient’s risk factors––what have they grown in the past? Are they at increased risk for resistance? Were they on prophylaxis? If so, a different med than their prophylactic med is indicated.
- What’s the duration? Data are the most limited here since cUTI is excluded from so many studies. While we are moving toward much shorter durations in simple cystitis, and there’s no evidence for a duration less than 10–14 days. Children with abscesses or nephronia may need even longer.
- Who needs prophylaxis? Not many; some specific subgroups benefit, but you risk increased resistance. You should be following up at least every 6 months to assess continued need.
How does this change my practice?
I’m picking up what the authors are putting down. Many of the patients admitted for UTI fall into the complicated category, and this comprehensive review does a nice job of breaking down common sticking points. I’d love some more research on duration in this population, as it hurts to think about 2 weeks of antibiotics in all these kids.
Source
Guidelines for Complicated Urinary Tract Infections in Children: A Review by the European Society for Pediatric Infectious Diseases. Pediatr Infect Dis J. 2025 Jun 1;44(6):e211-e223. doi: 10.1097/INF.0000000000004790. Epub 2025 Mar 19. PMID: 40106750
