Urinary Tract Infection In Children Research Articles

First episode of febrile urinary tractinfection in children, detection and risk factors of kidney scarring: Aprospective cohort study.

This prospective study aimed to evaluate the characteristics and findings of children who presented with acute pyelonephritis (APN) and to determine the independent risk factors for kidney scarring. Patients who satisfied the following criteria were enrolled in the study: first known episode of APN; at least two of the following findings: fever ≥ 38.5 °C, white blood cell count ≥ 10,000/mm3, erythrocyte sedimentation rate ≥ 20 mm/h, C-reactive protein ≥ 20 mg/dL; absence of congenital abnormalities or other kidney and systemic diseases, except vesicoureteral reflux (VUR); no APN relapses until the time of kidney scar detection. 99mTc-Dimercaptosuccinic acid kidney scintigraphy (99mTc-DMSA) was performed at admission, along with a kidney ultrasound. Follow-up 99mTc-DMSA took place after 6 months. Radiographic cystourethrography for VUR detection and grading was performed 1 month after the acute infection. We enrolled 70 children in the study. The kidney ultrasound failed to diagnose more than half of the cases of APN. VUR was found in 21.5% of children. 75% had findings of APN in the acute phase through 99mTc-DMSA, while in the second 99mTc-DMSA, there was a complete remission in 68% of them. Scars were observed more frequently in older children, children with VUR grade ≥ III, and children not on antibiotic prophylaxis. VUR did not appear to be associated with the first episode of APN, and children older than 1 year of age had a higher risk of scarring. Antibiotic prophylaxis may prevent kidney scarring due to host immunomodulatory effects, but more studies are needed so that conclusions can be drawn.

Urinary Tract Infections in Children.

Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.

Proportion of Urinary Tract Infection in Children between 6 Months to 5 Years of Age Presenting with Fever

Proportion of Urinary Tract Infection in Children between 6 Months to 5 Years of Age Presenting with Fever

Intravenous antibiotics for urinary tract infections in children with neurologic impairment.

Children with high-intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure. To determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI. We performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1-18 years) with HINI. The primary outcome was UTI readmission within 30 days. Our secondary outcome was the association of hospital-level variation in short IV antibiotic course use with readmission. Readmission rates were compared between short and long courses using multivariable regression. Of 5612 hospitalizations, 3840 (68.4%) had short IV antibiotic courses. In our adjusted model, children with short IV courses were less likely than with long courses to have a 30-day UTI readmission (4.0%, 95% CI [3.6%, 4.5%] vs. 6.3%, 95% CI [5.1%, 7.8%]). Despite marked hospital-level variation in short IV course use (50.0%-87.5% of hospitalizations), there was no correlation with readmissions. Children with HINI hospitalized with UTI had low UTI readmission rates, but those who received long IV antibiotic courses were more likely to experience UTI readmission versus those receiving short courses. While residual confounding may influence our results, we did not find that short IV courses impacted readmission at the hospital level despite variation in use across institutions. Long IV antibiotic courses are associated with risks and may not confer benefit in this population.

Urinary Tract Infections in Children

Patient Education| 2021 Urinary Tract Infections in Young Children Connected Content Translation: Infecciones de las vías urinarias en niños pequeños: (Urinary Tract Infections in Young Children) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Urinary Tract Infections in Young Children. Pediatric Patient Education 2021; 10.1542/peo_document109 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Topics: urinary tract, urinary tract infections, urine, urinary bladder, kidney, fever The urinary tract makes and stores urine. It is made up of the kidneys, ureters, bladder, and urethra (see illustration). The kidneys produce urine. Urine travels from the kidneys down 2 narrow tubes called the ureters to the bladder. The bladder is a thin muscular bag that stores urine until it is time to empty urine out of the body. When it is time to empty the bladder, a muscle at the bottom of the bladder relaxes. Urine then flows out of the body through a tube called the urethra. The opening of the urethra is at the end of the penis in boys and above the vaginal opening in girls. Normal urine has no germs (bacteria). However, bacteria can get into the urinary tract from 2 sources: (1) the skin around the rectum and genitals and (2) the... © 2010 American Academy of Pediatrics, Reaffirmed 01/2017. All rights reserved. You do not currently have access to this content.

Biomarkers for urinary tract infection: present and future perspectives.

A prompt diagnosis of urinary tract infection (UTI) is necessary to minimize its symptoms and limit sequelae. The current UTI screening by urine test strip analysis and microscopic examination has suboptimal diagnostic accuracy. A definitive diagnosis of UTI by urine culture takes two to three days for the results. These limitations necessitate a need for better biomarkers for the diagnosis and subsequent management of UTI in children. Here, we review the value of currently available UTI biomarkers and highlight the potential of emerging biomarkers that can facilitate a more rapid and accurate UTI diagnosis. Of the newer UTI biomarkers, the most promising are blood procalcitonin (PCT) and urinary neutrophil gelatinase-associated lipocalin (NGAL). PCT can provide diagnostic benefits and should be considered in patients who have a blood test for other reasons. NGAL, which is on the threshold of clinical care, needs more research to address its scope and utilization, including point-of-care application. Employment of these and other biomarkers may ultimately improve UTI diagnosis, guide UTI therapy, reduce antibiotic use, and mitigate UTI complications.

Evaluation of Routine Urine Analysis in Diagnosing Urinary Tract Infection among Pediatric Population: A Validation Study

Background: Urinary tract infection (UTI) stands out as one of the most common bacterial infections affecting children below the age of five. A valid diagnostic test for UTI is of utmost importance for avoiding bacterial resistance.Objectives: To assess the diagnostic efficacy of routine urine examinations in detecting urinary tract infections in pediatric patients, employing urine culture as the reference standardMaterial and Methods: This diagnostic study was conducted at leady reading hospital, Peshawar. The study employed a non-probability consecutive sampling technique and included 130 children between the ages of 1 and 5 years, regardless of gender, who exhibited symptoms suggestive of urinary tract infections. Exclusion criteria comprised children who had taken antibiotics within the past 48 hours, those with congenital renal anomalies such as renal or renal tumors, renal tract obstruction, and acute renal failure. All participants underwent urine regular examination and urine culture. Sensitivities, specificities, and accuracy were calculated, and the data was further stratified based on gender and age.Results: The mean age of the participants was 2.646±1.32 years. The males were predominant (n-86, 66.2%). The urine examination demonstrated a specificity of 90.91% and a sensitivity of 58.06% in detecting urinary tract infections. A statistically significant difference was observed when comparing the diagnosis of Urinary tract infections using urine culture and urine examination.Conclusion: While urine examinations exhibit satisfactory specificity, their sensitivity is insufficient to be utilized as a reliable diagnostic test for detecting urinary tract infections in children. Clinicians are advised to depend on urine culture for accurate diagnosis in such cases.Keywords: Diagnostic accuracy, Pediatrics, Urine Microbiology, Urinalysis, Urinary tract infection.

Review of clinical guidelines for the diagnosis, treatment and prevention of urinary tract infection in children

Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. The difficulty of diagnosis and timely administration of adequate therapy is associated with differences in the clinical course of the disease in different age groups, localization of the infectious process (upper and lower urinary tract), methods of urine collection and interpretation of the obtained results. The possibility and amount of instrumental diagnostics also varies depending on the region and the specifics of the organization of the healthcare system. The problem of increasing resistance of microorganisms is aggravated by the often-excessive prescription of antimicrobial chemotherapy drugs, which leads to a narrowing of the range of available drugs and the possibility of their use in appropriate age groups. All of the above explains the lack of uniform approaches and the existence of many international and local clinical recommendations on the problem of UTI. This review highlights the features of urine collection in non- and toilet-trained children and also discusses the assumptions and limitations of using screening methods for urinalysis. Indications for urine culture and differences in the interpretation of results depending on the method of obtaining a urine sample are presented, as well as data on modern instrumental diagnostic methods and strategies for their use in practice. A comparative description of current international clinical recommendations for the diagnosis, treatment and prevention of UTIs in children is provided.

Effect of probiotics on urinary tract infections in children: A systematic review and meta-analysis.

Urinary tract infections (UTIs) are the most prevalent bacterial infections that occur in children worldwide. This meta-analysis aims to investigate the utility of probiotics as preventive therapy in children with a UTI. The Web of Science, PubMed, and Scopus were searched for articles that investigated the relationship between probiotic consumption and the risk of UTIs. The quality of the articles was evaluated using the Jadad scale. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Subgroup analyses and sensitivity analyses were also conducted. The Cochran Q test and the statistic I2 were used to evaluate heterogeneity. To determine any potential publication bias, the Egger's and Begg's tests were used. In total, eleven studies were selected for systematic review and meta-analysis. Compared to children who did not receive probiotics, the OR of developing or having a recurring urinary tract infection in those who received probiotics was 0.94 (95% CI; 0.88-0.999; p-value=0.046). The Begg's and Egger's tests showed no evidence of publication bias between probiotics and the risk of developing new or recurring urinary tract infections. Based on this systematic review and meta-analysis, probiotics could be an alternative therapy for children who are at risk of developing a UTI. They are non-pharmaceutical options and could be used as natural prophylaxis for UTIs. However, the currently published evidence does not irrefutably confirm that probiotics provide a protective effect against urinary bacterial infections. Therefore, there need to be large-scale randomized clinical trials undertaken to investigate the possible prophylaxis of probiotics.

Should you test for urinary tract infection in children with respiratory symptoms?

An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely. In infants with fever and respiratory symptoms, who should have a sample collected for urinalysis for UTI? The approach to diagnosing febrile infants who have respiratory symptoms varies by age. Urinalysis should be done for all febrile infants younger than 2 months of age, regardless of whether they have respiratory symptoms. Clinicians should assess risk factors for UTI in every infant between 2 and 24 months of age and should not exclude the diagnosis of UTI based on respiratory symptoms alone. Use of a predictive tool to estimate the pretest probability of UTI would aid decision making about patients in this population.

Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study.

Urinary tract infections (UTIs) in childhood are common and are associated with considerable acute morbidity and long-term complications. The need for updated data to optimize empiric antibiotic therapy is crucial. We aimed to investigate the pathogens causing pediatric community acquired UTIs, their correlation with demographic characteristics, and trends in their antimicrobial resistance. This nationwide cross-sectional study included all 53,203 children (<18 years) diagnosed with UTI in community outpatient clinics in the following selected years: 2007, 2011, 2015, 2019 and 2021. Escherichia coli (E. coli) (82.1%) was the most common uropathogen, followed by Enterobacter, Klebsiella, Proteus, Pseudomonas, and Enterococcus species. The bacterial distribution displayed statistically significant (p < 0.0001) gender- and sector-specific patterns with a higher relative prevalence of non-E. coli UTI in Jewish and males. The rate of extended-spectrum beta-lactamase-positive E. coli increased substantially and significantly (p < 0.001) from only 6.1% in 2007 to 25.4% in 2021. Most non-E. coli uropathogens exhibited resistance to commonly used empiric antibiotics for UTIs in children. These findings are significant in guiding optimal empiric antibiotic treatment for pediatric community acquired UTIs. The resistance of uropathogens to antimicrobials is region- and time-dependent. Therefore, the periodic and local assessment of antibiotic resistance trends is essential to update guidelines and provide the most appropriate antibacterial therapy for children with UTIs.

Risk Factors for Urinary Tract Infections in Children with Hematuria in the Emergency Department.

Hematuria is a worrisome symptom in children and is sometimes associated with urinary tract infections (UTIs). This study aimed to identify useful clinical factors that can predict UTIs in hematuria patients without pyuria in the pediatric emergency department (ED). We retrospectively recruited patients with hematuria from the pediatric ED. Clinical symptoms, urine biochemistry and microscopic examination results, and blood laboratory tests were analyzed to identify the predictors of UTIs. Patients were divided into the verbal group (age ≥ 2 years) and non-verbal group (age < 2 years) for identifying predictors of UTIs. Causes of hematuria were also investigated. A total of 161 patients with hematuria without pyuria were evaluated. Among symptoms, dysuria was significantly correlated with UTIs. Regarding urine biochemistry data, urine esterase and urine protein > 30 mg/dl were found to be significant parameters for predicting UTIs, while urine esterase and urine nitrite showed significant differences in children with age < 2 years. In the urine microscopic examinations, urine red blood cells (RBC) > 373/µL in children aged ≥ 2 years and urine RBC > 8/µL in children aged < 2 years were associated with UTIs. In addition, UTIs and urinary tract stones were found to be the top two causes of hematuria. Dysuria, urine esterase, urine nitrite, and urine protein may be useful parameters for predicting UTIs in pediatric patients with hematuria but no pyuria in the ED. In addition, a UTI was the most commonly identified etiology of hematuria without pyuria, followed by urinary tract stones.

The Evolution of Guidelines for the Evaluation and Management of Urinary Tract Infections in Children: Can We Finally Agree?

The Evolution of Guidelines for the Evaluation and Management of Urinary Tract Infections in Children: Can We Finally Agree?

THE EFFECT OF CEFIXIME IN TREATING RESPIRATORY TRACT AND URINARY TRACT INFECTIONS IN CHILDREN

Third generation cephalosporins are commonly used for the treatment of diverse infections in children. Cefixime is an oral third-generation cephalosporin with a broad-spectrumantibacterial activity and a relatively long elimination half-life. It is available in oral, intravenous, and intramuscular forms. It is effective against certain bacteria, such as Streptococci, Neisseria gonorrhoeae, Moraxella catarrhalis, Haemophiles influenzae, and Gram-negative bacilli. However, it is poorly active against Staphylococcus aureus, Coagulase-negative Staphylococci, and Enterococci. Clinical trials have shown that cefixime is comparable to amoxicillin and cefaclor in treating acute otitis media in children caused by various organisms, including Streptococcus pneumoniae. It is more potent than other cephalosporins against Enterobacteriaceae but less activeagainst ciprofloxacin. The recommended dosage for children is 8 mg/kg/day orally, once daily or in two divided doses and the most prominent side effect is diarrhea, which occurs in up to16% of children. Cefixime is a safe and effective for treating upper respiratory tract infections and acute otitis media. However, there is insufficient evidence regarding its efficacy in treating sinusitis and lower respiratory tract infections in children as its antimicrobial spectrum does cover the bacteria commonly associated with these infections. Due to its partial excretion through the kidneys, cefixime is frequently used to treat urinary tract infections in children.

Urinary tract infection in pediatric patients – Recent updates

In children, urinary tract infection (UTI) is a common condition. Prompt identification and treatment are critical for reducing morbidity associated with this illness. Throughout infancy, the symptoms and indications remain nonspecific. During the first 2 years of life, the most prevalent sign of UTI is unexplained fever. Symptoms and indicators of pyelonephritis after the 2nd year of life include fever, chills, rigor, flank discomfort, and costovertebral angle tenderness. Suprapubic pain, dysuria, urinary frequency, urgency, murky urine, malodourous urine, and suprapubic tenderness are examples of the lower tract symptoms and indicators. When UTI is suspected, a urinalysis and urine culture should be conducted. In the treatment of acute uncomplicated UTI, second or third-generation cephalosporin and amoxicillin-clavulanate are currently the medications of choice. Parenteral antibiotic therapy is advised for infants under 2 months of age and any child who seems toxic is hemodynamically unstable, is immunocompromised, is unable to tolerate, or is not responding to oral medication. This study focuses on the most recent updates about UTIs in children and provides a comprehensive overview of the subject.

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic.

Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes. To examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity. This retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021. Time periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021). The primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis. The cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: -33.1% (95% CI, -39.4% to -26.1%) for all children and -52.1% (95% CI, -62.1% to -39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (-4.3%; 95% CI, -32.0% to 34.6% for all children) after the first 3 months of the pandemic. In this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

Urinary tract infections in children with cancer and febrile neutropenia - single center experience

Background/Aim. Urinary tract infection (UTI) in children with febrile neutropenia (FN) after receiving chemotherapy could be followed by atypical symptoms and signs. The absence of routine urine culture (UC) sampling for analysis could lead to undiagnosed disease and inadequate treatment of these patients. The aim of the study was to indicate the importance of sampling UC in children who have developed FN and to point out the most probable causative agents of UTI in children with FN and antibiotic sensitivity/resistance of the isolated strains. Methods. During a five-year observation period, 40 UTIs were registered in 30 patients with FN. In the study group of patients with FN, the number of UTIs, the number of recurrent UTIs, isolated pathogens, their sensitivity to antibiotics, characteristics of urine sediment, the presence of localized symptoms of UTI, and the presence of urosepsis were analyzed. The obtained results were compared with the control group which consisted of children who were healthy prior to hospitalization due to febrile urinary infection. Results. When compared to the control group, significant differences in the presence of symptoms of UTI and urine sediment findings in patients with FN were observed. A higher percentage of resistant strains of Escherichia coli isolated from UC of cancer patients with FN was noted when compared to the control group. Three UTI cases were followed by urosepsis. Conclusion. UC findings are important not only in establishing the diagnosis of UTI and detecting multi-resistant bacterial strains but also in choosing appropriate antibiotics and selecting a subgroup of patients with recurrent UTI who require further monitoring and detecting potential complications in a timely manner.

Urinary Tract Infection in Children: A Narrative Review.

This study investigates the susceptibility of different age groups and genders to urinary tract infections (UTIs) in pediatric populations, focusing on anatomical and behavioural factors. A systematic review of clinical data explores manifestations, accurate diagnosis methods, and antibiotic treatment regimens. Escherichia coli is a prevalent uropathogen, and the study addresses concerns about antibiotic resistance. The research aims to close knowledge gaps, influence guidelines, and enhance public health initiatives. Factors influencing UTI prevalence, such as age, gender, and structural abnormalities, are discussed. The review follows a robust search methodology, presenting a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The included studies cover a wide range of topics related to pediatric UTIs, including aetiology, treatment, prevention, and diagnostic approaches. The study emphasizes the importance of understanding and addressing pediatric UTIs for effective management and prevention.

A cross-sectional study of clinical a nd microbiological profile of urinary tract infections in children from tertiary care centre in Maharashtra

Abstract Introduction: Urinary tract infections (UTIs) are common in children, often leading to renal damage if not promptly treated. Understanding the changing epidemiology, causative agents, and antibiotic resistance patterns is crucial for effective management. Methods: A cross-sectional study was conducted at a tertiary care hospital. 100 children aged 1 month to 18 years diagnosed with UTI based on symptoms, pyuria, and bacteriuria were enrolled. Data on demographics, clinical features, and antibiotic use were collected. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Results: Infants (&lt;1 year) showed a higher male prevalence (69.6%) compared to females (30.4%). Fever was the most common symptom (92%). Escherichia coli (E. coli) was the predominant pathogen (69%), followed by Klebsiella pneumoniae (10%) and Enterobacter spp. (6%). Antibiotic resistance was observed, with 20% sensitive to 4 or fewer antibiotics and 27% sensitive to 9-12 antibiotics. Prior urinary instrumentation, past UTI history, and recent antibiotic use were identified as risk factors for resistance. ESBL-producing organisms showed significant resistance to cephalosporins and ciprofloxacin compared to non-ESBL organisms. Conclusions: UTIs in children show age-specific gender variations and evolving bacterial profiles. E. coli remains the dominant pathogen, but resistance is rising. Prior interventions, past UTIs, and recent antibiotic use are associated with resistance. ESBL-producing organisms pose a particular challenge. These findings highlight the need for judicious antibiotic use and tailored management strategies based on age, bacterial profile, and resistance patterns.

Urinary tract infections in children in the era of growing antimicrobial resistance – recommendations of the Polish Society of Paediatric Nephrology

Introduction and objective: Urinary tract infections can recur in children, and due to their potential long-term consequences, they require appropriate diagnosis and prompt treatment. Although Escherichia coli is the most common aetiology, an increase in infections with drug-resistant strains has been observed. The aim of this study was to develop current diagnostic and treatment recommendations in the era of increasing microbial resistance. Materials and methods: The recommendations are based on updated guidelines developed by the experts of the Polish Society of Paediatric Nephrology and a literature review. Results: Because the symptoms of urinary tract infection are often non-specific, urinalysis and urine culture should be performed in children presenting with fever without an identifiable cause. Correct method of urine collection and interpretation of the results are crucial for therapeutic decisions. Treatment should be continued for 7–14 days for upper and 3–5 days for lower urinary tract infections; the choice of the narrowest-spectrum antimicrobial should be based on bacterial susceptibility. Antibiotic prophylaxis is limited and recommended in children with grade III–V vesicoureteral reflux. Non-pharmacological management should include treatment of bladder and bowel dysfunction. Ultrasound is recommended for all children up to 24 months of age. Indications for voiding cystourethrography are limited to cases with ultrasound abnormalities, recurrent and septic infections. Conclusion: The paper provides up-to-date, practical recommendations for the diagnosis and management of urinary tract infections in children in the era of increasing microbial resistance and restricted indications for invasive radiological investigations.