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Multicenter Study
. 2022 Jul;181(7):2663-2671.
doi: 10.1007/s00431-022-04457-0. Epub 2022 Apr 6.

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Francesca Cenzato #  1   2 , Gregorio P Milani #  3   4 , Angela Amigoni  5 , Francesca Sperotto  5 , Mario G Bianchetti  6 , Carlo Agostoni  1   2 , Giovanni Montini  1   7 ; ItaUTI study group
Collaborators, Affiliations
Multicenter Study

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Francesca Cenzato et al. Eur J Pediatr. 2022 Jul.

Erratum in

Abstract

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques. What is Known: • Several guidelines are published on the management of children with suspected or confirmed urinary tract infection. • No data are available on the management of pediatric urinary tract infections in the emergency setting. What is New: • Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture. • Diagnostic CFU thresholds largely vary among centers.

Keywords: Catheter; Emergency department; Guidelines; Infants; Infection; Survey; Urinary tract; Urine.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Italian provinces with at least one unit invited: in grey color those with at least one participant center, in light gray color those without any participating unit. We were not able to invite any unit in two provinces (dark gray color)
Fig. 2
Fig. 2
Left: bacterial load (colony-forming units/ml) considered diagnostic for urinary tract infection in urine collected by perineal bag. Right: bacterial load (colony-forming units/ml) considered diagnostic in urine collected by bladder catheter
Fig. 3
Fig. 3
Left: indications for kidney-urinary tract ultrasound in a febrile child in a good condition with a first episode of UTI. Right: timing of kidney-urinary tract ultrasound
See this image and copyright information in PMC

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