The Febrile Infant with Urinary Tract Infection: An Evidence-Based Review from Emergency Diagnosis to the Prevention of Renal Scarring
Abstract
Background: Urinary tract infections (UTIs) are a frequent cause of serious bacterial illness in febrile infants <24 months of age. They pose a formidable diagnostic challenge in the emergency department (ED) because of their non-verbal status and lack of specificity, and management dilemmas span acute treatment to prevention of long-term renal complications.
Aim: This systematic review integrates the evidence (2015-2024) to provide a clear framework for the management of febrile infant UTIs from ED diagnosis through preventing CKD, focusing on diagnosis, treatment, imaging controversies, and follow-up.
Methods: A systematic review of more recent literature was conducted, evaluating evidence regarding diagnostic accuracy of urinalysis and culture methods, effectiveness and resistance patterns of empiric antibiotic treatment, and outcomes with various imaging strategies and prophylactic measures.
Results: Evidence supports catheterization to diagnose for accurate urine culture. Empiric antibiotic choice must be based on local resistance patterns, often favoring cephalosporins. Imaging is risk-stratified; renal bladder ultrasound is non-specific, but voiding cystourethrogram is reserved for abnormal ultrasounds or recurrent infection. Prophylactic antibiotic administration is now restricted to high-risk cases, as it has little value in preventing renal scarring in most children.
Conclusion: An efficient, evidence-based pathway—from appropriate ED diagnosis and targeted treatment to selective imaging and nephrology follow-up of high-risk infants—is required for acute care and long-term renal function preservation, preventing unnecessary interventions while avoiding sequelae like hypertension and CKD.
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References
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Authors
Copyright (c) 2024 Maryam Zeinelabdin, Areej Adel Sheerah, Ashwaq Muhammad Alyazeedi, Yafeah Ali Hussain Al Rebeh, Neda Ali Abdullah Aldawood, Nawaf Mohammed Eid Almogati, Rabab Abdullah Ali Lajami, Hawra Hussain Alsalem, Zainab Abdulmohsen Almuallem, Zainab Ali Al Qambar, Thara Alawi Alsharfa, Hawra Ali Alqamber, Fatimah Saeed Alkhater, Deena Abdullah Al Saglab
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