Section on Urology Response to New Guidelines for the Diagnosis and Management of UTI

* Abbreviations: RBUS — : renal and bladder ultrasound UTI — : urinary tract infection VCUG — : voiding cystourethrogram VUR — : vesicoureteral reflux This commentary provides a summarized response regarding the newly published American Academy of Pediatrics Guidelines on urinary tract infection (UTI) diagnosis and evaluation from the Section on Urology of the American Academy of Pediatrics. Although the section supports some aspects of the guidelines, the new recommendation not to perform a voiding cystourethrogram (VCUG) after a first febrile UTI is not supported. The section expresses significant concern that the recommendation is based on a flawed interpretation of limited data and that this stands to potentially harm significant numbers of children because of delayed diagnosis of harmful urinary tract conditions. The Section of Urology of the American Academy of Pediatrics enthusiastically supports many aspects of the new Guideline on UTI evaluation and management. Specifically, when faced with a febrile sick child (aged 2 months to 2 years), UTI should be considered a significant cause and a urine culture be obtained by urethral catheterization or suprapubic aspiration. Bag urine cultures are not recommended. Antibiotic therapy should not be started without a urine culture. The presence of ≥50 000 CFU/mL is now considered to be diagnostic of UTI, and oral or parenteral antibiotic therapy, tailored to bacterial sensitivity and clinical efficacy, is adequate initial therapy. Under the 1999 Guideline, after a culture-proven febrile UTI, the recommended workup included a renal and bladder ultrasound (RBUS) and a VCUG.1 The new Guidelines recommend that an RBUS be performed but that a VCUG not be done if the RBUS is normal. This represents a paradigm shift in the evaluation of children with a febrile UTI. We agree that an ultrasound should be performed in a child after a febrile UTI; we do … Address correspondence to Craig A. Peters, MD, 111 Michigan Ave, NW, Washington, DC, 20010. E-mail: crpeters{at}childrensnational.org