Pediatric Urinary Tract Infection

Nationally recognized researchers at Children’s Hospital of Pittsburgh of UPMC have changed common practices for urinary tract infections (UTI), and have improved the lives of children in the process. Our studies have shown that UTI are the most frequently occurring serious infections in children. By developing highly accurate diagnostic criteria, we are now able to treat children as outpatients with oral antibiotics, rather than admitting them to the hospital for intravenous therapy. And our clinical research team is currently studying shorter treatment courses, the use of prophylactic antibiotics, biomarkers for diagnosing kidney infections, and the efficacy of steroids in preventing renal scars.

A Multidisciplinary UTI Center

Children’s Hospital of Pittsburgh’s UTI Center coordinates research, information, and support for community practitioners and parents, with the goal of promoting early diagnosis and evidence-based care for children with UTI. The center’s multidisciplinary approach combines the capabilities and expertise of the divisions of general academic Pediatrics, Urology, and Nephrology, as well as the Department of Pediatric Radiology.

In Pediatric Nephrology, researchers are investigating genetic reasons for vesicoureteral reflux (VUR) and urinary tract obstructions in children. Urology provides management of problems, including surgical corrections when needed, and voiding dysfunction through its Healthy Elimination Learning Program (HELP). HELP provides evaluation and treatment to children with a history of UTI, day and nighttime urinary incontinence, and voiding symptoms such as urgency, frequency, and incomplete bladder emptying.

Through a multidisciplinary approach, Children’s Hospital can help to prevent long-term UTI complications, including:

• High blood pressure
• Kidney failure
• Problems during pregnancy

A National Research Leader

Experts at Children’s Hospital turned their focus to pediatric UTI more than 20 years ago. During this time, research has investigated:

• Prevalence — In the late 1980s, a study looked at the frequency of UTI in febrile infants under 1 year old who presented to the emergency department. Of the 1,000 babies studied, 5 percent were found to have UTI. This was especially high (16 percent) in female Caucasian babies.
• Laboratory methods — Methods reported from adult women’s studies were used to improve the urinalysis used in the first study. Researchers added a gram stain smear of urine, making it easier to see the bacteria. By gathering urine specimens from nearly 6,000 babies, researchers demonstrated that the new method was superior to standard procedures.
• Treatment — A clinical trial with 310 children looked at whether children could be treated, with the same or better outcomes, on an outpatient basis using oral medication instead of as inpatients with intravenous antibiotics. The study found that there was no increased risk of kidney scarring by treating children as outpatients with oral medication.
• Imaging — A study about the effectiveness of UTI imaging techniques, published in the New England Journal of Medicine in 2003, evaluated 300 children between 1 and 24 months after their first febrile UTI. They assessed the value of imaging studies in altering management or improving outcomes of UTI^_.

Click here for more information about guidelines and published articles, or visit our chronology of published research since 1993.

Moving Forward

Research at Children’s Hospital has led to more effective diagnosis and treatments for children with UTI, giving them the best possible chances of achieving a successful outcome. Researchers shared findings and expertise used to help develop the American Academy of Pediatrics (AAP) guidelines for UTI diagnosis and treatment, the latest of which were published in the September 2011 issue of Pediatrics.

Clinicians and researchers continue to look at ways in which diagnosis and treatment can be improved, and how their work can support the pediatric community. Current research includes:

• RIVUR (Randomized Intervention for Vesicoureteral Reflux) — A randomized, placebo-controlled follow-up study of children with VUR, trying to determine whether prophylaxis with antibiotics is beneficial.
• CUTIE (Careful UTI Evaluation) — A study that looks at the risk factors resulting in renal scars from UTI for children who do not have VUR.

New studies include:

• Biomarkers — Led by Nader Shaikh, MD, this study looks at biomarkers to distinguish between kidney and bladder infections among children with febrile UTI.
• STARRS (Steroids to actively reduce renal scarring)— Also led by Dr. Shaikh, this project will determine whether an intervention with corticosteroids can reduce the likelihood of kidney scars among children with acute febrile UTI.
• SCOUT (Short course therapy) — This study investigates whether children with UTI can be effectively treated with five days of antibiotics instead of 10, which is the present standard of care. Studies have shown that shorter courses of antibiotics are effective in treating UTI in adults.