Urinary sepsis in children: a systematic review of diagnostic and therapeutic aspects

During the last decade, new imaging techniques and biological probesprovided further insight into the pathogenesis and natural history ofurinary tract infection (UTI) in children. Especially in newborns, UTIis a common cause of fever and probably the most common causeof renal parenchymal loss. In children aged equal or less than 2years, the symptoms of UTI are vague and non-specific - fever,irritability, poor feeding, vomiting, diarrhea and ill appearance. Inneonates, clinical symptoms or laboratory tests could not be usedto predict UTI episodes or eliminate the likelihood of a UTI even ifother sites of infections are clinically suggested. For this reason, thegoal of managing UTI in children is based on identifying and modifyingfactors that may increase the risk of renal parenchymal and functionalloss as from the onset of infection. Moreover, selective antimicrobialpressure is a major concern when treating children with UTI, asrenal parenchymal loss may occur within a short period of time, ifinadequate antimicrobial agents are utilized. OBJECTIVES: Thissystematic review assessed recent diagnostic and therapeuticaspects of severe UTI in children. We also summarized wellconductedstudies and the most important publications regardingdiagnosis and treatment of urinary sepsis in the pediatric population.SEARCH STRATEGY: Trials and reviews were searched in generaland specialized databases (MEDLINE, Cochrane Library) andreferences were reviewed. SELECTION CRITERIA: All publishedtrials and reviews were eligible for inclusion provided they reportedresults for the pediatric population, included clinically significantevents resulting from urinary tract infection, and included specificaspects of diagnosis and therapy. DATA COLLECTION: One reviewerextracted Information. Diagnostic and therapeutic aspects of urinarysepsis in the pediatric age group were assessed.