Febrile UTI in kids: Major change in workup
SHORT ANSWER MANAGEMENT POP QUIZ:
- What is the BEST initial investigation for children 2 months - 2 years old with a first febrile UTI?
- Other than E. Coli, name FOUR Species of of bacteria that cause UTIs in children
- In a penicillin-allergic patient with UTI, name THREE parenteral antibiotics used for empiric treatment
(Answers are in the blog post below or the linked guideline.)
What's the latest in pediatric UTI, you ask? Well, it turns out that the CPS released a position statement (otherwise known as a national guideline) on pediatric UTI in 2014. If you're reading a resource from before then, you're out of date! At The Review Course this year, we went over several important changes from this CPS position statement. I'd like to tell you about one of the most important ones. Remember the voiding cystourethrogram from medical school? The VCUG used to be a standard recommendation for the workup of febrile UTI in children under two years. Now, it's out! That's right, a VCUG is no longer recommended as a first line investigation for febrile UTI. It's uncomfortable, involves radiation, and has a risk of infection. But that's not the reason it's no longer first line -- it's because it doesn't change management. Why not? The theory behind doing VCUG was to pick up vesicoureteral reflux (VUR). Everybody with VUR used to get antibiotic prophylaxis for recurrent UTI. However, evidence has shown that only grades IV and V VUR really benefit from antibiotic prohpylaxis. Grade IV and V VUR are associated with demonstrable hydronephrosis, which can be reliably detected on renal and bladder ultrasound. Therefore, we can pick up any clinically significant VUR with an ultrasound. You should be able to confidently recommend this as the appropriate imaging test for children aged 2 months to two years with a first febrile UTI. Reference: http://www.cps.ca/documents/position/urinary-tract-infections-in-children