Approach to Pediatric Patients with UTI in the PICU.

Urosepsis and UTI are common causes and comorbidities in children admitted to the pediatric intensive care unit (PICU). Risk factors for morbidity and mortality in pediatric patients include young age (< 2 years old), presence of congenital renal anomalies of the urinary tract, and immunosuppression from transplant (kidney, liver, heart, and bone marrow). Workup of urosepsis focuses on identification of renal anomalies of the urinary tract through ultrasound, X-ray cystourethrogram, urodynamic studies, and CT/MRI. Management consists of appropriate choice in antibiotics, hemodynamic instability, and prevention of acute kidney injury (AKI) with particular recognition that chronic renal failure can be present in all chronically ill children, which is not limited to pediatric patients with congenital anomalies of the kidney urinary tract. This review includes a review of the workup and management of pediatric patients with UTI and urosepsis in both healthy patients and patients with known anomalies of the urinary tract.