Urinary tract infections: An overview of urine collection, imaging, and prevention

The management of children with a febrile urinary tract infection has always been a matter of debate. While some recent trials have succeeded in leading to agreement on certain issues, other important points of contention remain, in particular urine collection methods, imaging strategies, and prevention of recurrence. All urine collection methods, both invasive and noninvasive, carry a risk of contamination by bacteria not present in the bladder, with a mean rate of 25 %. In our opinion, clean-voided methods should be the first choice as they are relatively easy to perform, reliable, cost-effective, and acceptable to children, parents, and caregivers. We suggest using invasive methods only when a child is in poor general health. The need for imaging after a first febrile urinary tract infection has long been debated. New insights have led the authors of the current guidelines to consider less aggressive imaging strategies than before. Considering the high rate of spontaneous resolution of vesicoureteral reflux with age and the good renal outcome for patients with scarring, without major congenital renal abnormalities, we discourage the routine execution of voiding cystography and renal DMSA scans. Many risk factors for recurrence have been described. While some are not modifiable (age, white race, familiarity), others (reflux, voiding habits, phimosis, bladder function, constipation, and fluid intake) can be modified through behavioral changes and/or medical interventions. Although some controversy regarding preventive interventions still exists, the role of antibiotic prophylaxis has been reassessed, and none of the more recent guidelines suggest a routine use.