Algoritmo Itu Pediatria

Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management Pediatrics 2011;128;595; originally published online August 28, 2011; DOI: 10.1542/peds.2011-1330

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest PointBoulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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FROM THE AMERICAN ACADEMY OF PEDIATRICS

CLINICAL PRACTICE GUIDELINE

Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis andManagement of the Initial UTI in Febrile Infants and Children 2 to 24 Months
SUBCOMMITTEE ON URINARY TRACT INFECTION, STEERING COMMITTEE ON QUALITY IMPROVEMENT AND MANAGEMENT
KEY WORDS urinary tract infection, infants, children, vesicoureteral reflux, voiding cystourethrography ABBREVIATIONS SPA—suprapubic aspiration AAP—American Academy of Pediatrics UTI—urinary tract infection RCT—randomized controlledtrial CFU—colony-forming unit VUR—vesicoureteral reflux WBC—white blood cell RBUS—renal and bladder ultrasonography VCUG—voiding cystourethrography This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through aprocess approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. The recommendations in this report do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Allclinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

abstract
OBJECTIVE: To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. METHODS:Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded. RESULTS: Diagnosis is made on the basis of the presence of both pyuria and at least 50 000 colonies per mL of a singleuropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use ofantimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either highgrade VUR or obstructive uropathy...