Bryant Penelope A, Bitsori Maria, Vardaki Kalliopi, Vaezipour Nina, Khan Maria, Buettcher Michael
From the Departments of Infectious Diseases and Hospital-in-the-Home, Royal Children's Hospital, Melbourne, Australia.
Clinical Infections, Murdoch Children's Research Institute, Melbourne, Australia.
Pediatr Infect Dis J. 2025 Jun 1;44(6):e211-e223. doi: 10.1097/INF.0000000000004790. Epub 2025 Mar 19.
Complicated urinary tract infections (cUTI) present a challenge to the clinician because of the variety in clinical syndromes included and consequent difficulties in synthesizing evidence. A harmonized definition of cUTI does not exist. In national guidelines, management recommendations for cUTI are often neglected. We aimed to define the four most important controversies and formulate management recommendations for cUTI in children and adolescents.
The European Society of Pediatric Infectious Diseases Guideline Committee convened a working group of experts from microbiology, pediatric nephrology and infectious diseases with expertise in managing children with UTI. A comprehensive literature review was done using PubMed, Embase and the Cochrane library to find studies in children under 18 years published until December 2024. Four controversies were defined from experience and available evidence. Children with cUTI were categorized into 5 subgroups: anatomical/functional urological abnormalities, multiple UTI recurrences, severe clinical presentation, nonurological underlying conditions and neonates. Respective management guidelines were formulated through the evidence and by consensus of working group members. Recommendations were made using GRADE criteria.
The term cUTI is generally used to define children with UTI with an increased likelihood of failing conventional management. The included 5 subgroups are the most likely to need additional investigations at diagnosis and during the course of infection, initial intravenous antibiotics, longer treatment duration, antibiotic prophylaxis, follow-up imaging and surgical referral. These are detailed for each subgroup.
These comprehensive guidelines offer evidence-graded recommendations specifically for pediatric cUTI, addressing gaps that exist in current guidelines.
复杂性尿路感染（cUTI）给临床医生带来了挑战，因为其所包含的临床综合征多种多样，导致综合证据存在困难。目前尚无统一的cUTI定义。在国家指南中，cUTI的管理建议常常被忽视。我们旨在明确四个最重要的争议点，并为儿童和青少年cUTI制定管理建议。
欧洲儿科传染病学会指南委员会召集了一个由微生物学、儿科肾脏病学和传染病学专家组成的工作组，这些专家在管理UTI患儿方面具有专业知识。利用PubMed、Embase和Cochrane图书馆进行了全面的文献综述，以查找截至2024年12月发表的18岁以下儿童的研究。根据经验和现有证据确定了四个争议点。cUTI患儿被分为5个亚组：解剖/功能性泌尿系统异常、多次UTI复发、严重临床表现、非泌尿系统基础疾病和新生儿。通过证据并经工作组成员达成共识制定了相应的管理指南。使用GRADE标准提出建议。
术语cUTI通常用于定义UTI患儿，这些患儿采用传统治疗方法失败的可能性增加。所纳入的5个亚组在诊断和感染过程中最有可能需要进行额外检查、初始静脉使用抗生素、延长治疗时间、抗生素预防、随访影像学检查和手术转诊。针对每个亚组都进行了详细说明。
这些全面的指南提供了专门针对儿童cUTI的循证分级建议，填补了当前指南中存在的空白。
