NICE | AAP | ISPN | Current practice | |||
---|---|---|---|---|---|---|
Urine collection | Clean catch (gold standard) If clean catch not possible, other non-invasive methods (pads) are recommended | Always catheterisation or suprapubic aspiration | In febrile children in good clinical conditions: clean catch; bag is a second option In severely ill children: catheterisation | <3 months | 4–36 months | |
Bag | 53.1% | 59.1% | ||||
Clean catch | 20.3% | 27.5% | ||||
Catheterisation | 19.7% | 10.7% | ||||
Suprapubic aspiration | 3.6% | 0 | ||||
MCU | <6 months of age: if positive ultrasonography or atypical UTI* >6 months: no, should only be considered in special circumstances† | Only if abnormalities are present on US (hydronephrosis, scarring or other findings suggesting high-grade VUR) or recurrence of febrile UTI | Only if abnormalities are present on US and/or if presence of risk factors‡ or recurrence of febrile UTI | Children 1–36 months of age | ||
Children with US abnormalities | 63.4% | |||||
Children <2 years with febrile UTI | 19.6% | |||||
Infants (<12 months) with febrile UTI | 12.1% | |||||
All children with UTI (febrile or not) | 4.8% | |||||
VUR and antibiotic prophylaxis | Insufficient evidence for children with complex urological conditions | No if reflux grades I-IV; no indications for grade V | No, if reflux grades I–II Yes, if reflux grades III–V | All children with grade III–V VUR | 38.6% | |
All children with any grade of VUR | 24.9% | |||||
All children with grade IV–V VUR | 24.1% | |||||
I do not prescribe antibiotic prophylaxis for any grade of VUR | 12.4% |
*Seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to correct antibiotic treatment within 48 h, or infection with organisms other than Escherichia coli.
†Dilatation on ultrasonography, poor urine flow, infection with organism other than E. coli, or family history of VUR.
‡Urinary tract abnormality on prenatal ultrasound, males less than 6 months of age, first-degree relatives with VUR, non E. coli infections, poor urinary stream, foreseeable non-compliance of the family.
AAP, American Academy of Paediatrics; ISPN, Italian Society of Paediatric Nephrology; MCU, micturating cystourethrogram; NICE, National Institute for Health and Care Excellence; UTI, urinary tract infection; VUR, vesicoureteral reflux.