Download PDF
Eur J Pediatr Surg 2015; 25(05): 414-420
DOI: 10.1055/s-0034-1384646
Original Article
Georg Thieme Verlag KG Stuttgart · New York

NICE Guidelines Cannot Be Recommended for Imaging Studies in Children Younger Than 3 Years with Urinary Tract Infection

Marko Tapani Ristola
1   Department of Pediatric Surgery, Turku University Hospital, Turku, Varsinais-Suomi, Finland
,
Timo Hurme
1   Department of Pediatric Surgery, Turku University Hospital, Turku, Varsinais-Suomi, Finland
› Author Affiliations
Further Information

Publication History

18 March 2014

22 May 2014

Publication Date:
31 July 2014 (online)

   Permissions and Reprints

Abstract

Introduction We assessed the possible consequences of applying the National Institute of Health and Clinical Excellence (NICE) guidelines for imaging studies of children younger than 3 years with urinary tract infection (UTI) to clinical practice, in terms of altered diagnoses and treatment.

Material and Methods In a retrospective cohort of 672 patients with UTI, we evaluated indications for and results of renal and bladder ultrasonography, voiding cystourethrography (VCUG), dimercaptosuccinic acid scintigraphy, UTI recurrence, antimicrobial prophylaxis (AMP), antireflux procedures, and other urological procedures.

Results There were a total 125 patients with vesicoureteral reflux (VUR), of whom 59 patients (47%) would have been missed, had the NICE guidelines being applied. These included 20 of the 64 patients (31%) with dilating VUR and 13 of the 30 patients (43%) who underwent antireflux procedures. A VCUG would have been avoided in 184 patients (74%) with no VUR in VCUG.

Conclusion Based on the results in this cohort of 672 patients, we cannot recommend the use of the NICE guidelines for imaging studies in children younger than 3 years with UTI.

Keywords

urinary tract infections - vesicoureteral reflux - child - NICE guidelines
 

  • References

  • 1 Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27 (4) 302-308
    CrossrefPubMedGoogle Scholar
  • 2 Hansson S, Martinell J, Stokland E, Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1997; 11 (3) 499-512
    CrossrefPubMedGoogle Scholar
  • 3 Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010; 126 (6) 1084-1091
    CrossrefPubMedGoogle Scholar
  • 4 Swerkersson S, Jodal U, Sixt R, Stokland E, Hansson S. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol 2007; 178 (2) 647-651 , discussion 650–651
    CrossrefPubMedGoogle Scholar
  • 5 National Institute for Health and Clinical Excellence. NICE clinical guideline 54. Urinary tract infection in children: Diagnosis, treatment and long-term management. Available at: http://www.nice.org.uk/nicemedia/live/11819/36032/36032.pdf Accessed December 12, 2013
    PubMedGoogle Scholar
  • 6 Roberts KB ; Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128 (3) 595-610
    CrossrefPubMedGoogle Scholar
  • 7 Jodal U, Lindberg U ; Swedish Medical Research Council. Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Acta Paediatr Suppl 1999; 88 (431) 87-89
    CrossrefPubMedGoogle Scholar
  • 8 Riccabona M, Avni FE, Blickman JG , et al. Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 2008; 38 (2) 138-145
    CrossrefPubMedGoogle Scholar
  • 9 Ammenti A, Cataldi L, Chimenz R , et al; Italian Society of Pediatric Nephrology. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 2012; 101 (5) 451-457
    CrossrefPubMedGoogle Scholar
  • 10 European Association of Urology. Guidelines: Online Guidelines (2012). Available at: http://www.uroweb.org/guidelines/online-guidelines/ . Accessed December 12, 2013
    PubMedGoogle Scholar
  • 11 Jose SS, Sharif ES. New NICE guidelines for UTI management: what will change?. Arch Dis Child 2008; 93 (8) 716-717
    PubMedGoogle Scholar
  • 12 Ristola MT, Hurme T. NICE guidelines for imaging studies in children with UTI adequate only in boys under the age of 6 months. Pediatr Surg Int 2013; 29 (3) 215-222
    CrossrefPubMedGoogle Scholar
  • 13 Schroeder AR, Abidari JM, Kirpekar R , et al. Impact of a more restrictive approach to urinary tract imaging after febrile urinary tract infection. Arch Pediatr Adolesc Med 2011; 165 (11) 1027-1032
    CrossrefPubMedGoogle Scholar
  • 14 Tse NK, Yuen SL, Chiu MC, Lai WM, Tong PC. Imaging studies for first urinary tract infection in infants less than 6 months old: can they be more selective?. Pediatr Nephrol 2009; 24 (9) 1699-1703
    CrossrefPubMedGoogle Scholar
  • 15 Wong SN, Tse NK, Lee KP , et al. Evaluating different imaging strategies in children after first febrile urinary tract infection. Pediatr Nephrol 2010; 25 (10) 2083-2091
    CrossrefPubMedGoogle Scholar
  • 16 Lytzen R, Thorup J, Cortes D. Experience with the NICE guidelines for imaging studies in children with first pyelonephritis. Eur J Pediatr Surg 2011; 21 (5) 283-286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE ; International Reflux Study in Children. International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 1985; 15 (2) 105-109
    CrossrefPubMedGoogle Scholar
  • 18 Lee HY, Soh BH, Hong CH, Kim MJ, Han SW. The efficacy of ultrasound and dimercaptosuccinic acid scan in predicting vesicoureteral reflux in children below the age of 2 years with their first febrile urinary tract infection. Pediatr Nephrol 2009; 24 (10) 2009-2013
    CrossrefPubMedGoogle Scholar
  • 19 Salo J, Ikäheimo R, Tapiainen T, Uhari M. Childhood urinary tract infections as a cause of chronic kidney disease. Pediatrics 2011; 128 (5) 840-847
    CrossrefPubMedGoogle Scholar
  • 20 Preda I, Jodal U, Sixt R, Stokland E, Hansson S. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 2007; 151 (6) 581-584 , e1
    CrossrefPubMedGoogle Scholar
  • 21 Tseng MH, Lin WJ, Lo WT, Wang SR, Chu ML, Wang CC. Does a normal DMSA obviate the performance of voiding cystourethrography in evaluation of young children after their first urinary tract infection?. J Pediatr 2007; 150 (1) 96-99
    CrossrefPubMedGoogle Scholar
  • 22 Brandström P, Jodal U, Sillén U, Hansson S. The Swedish reflux trial: review of a randomized, controlled trial in children with dilating vesicoureteral reflux. J Pediatr Urol 2011; 7 (6) 594-600
    CrossrefPubMedGoogle Scholar
  • 23 Nagler EV, Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2011; (6) CD001532
    PubMedGoogle Scholar
  • 24 Elder JS, Diaz M, Caldamone AA , et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol 2006; 175 (2) 716-722
    CrossrefPubMedGoogle Scholar
  • 25 Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006; 117 (3) 626-632
    CrossrefPubMedGoogle Scholar
  • 26 Venhola M, Uhari M. Vesicoureteral reflux, a benign condition. Pediatr Nephrol 2009; 24 (2) 223-226
    CrossrefPubMedGoogle Scholar
  • 27 Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I. The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 2005; 90 (7) 733-736
    CrossrefPubMedGoogle Scholar
  • 28 Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS. Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 2003; 14 (3) 739-744
    CrossrefPubMedGoogle Scholar
  • 29 Köllermann MW, Ludwig H. On vesico-ureteral reflux in normal infants and children [in German]. Z Kinderheilkd 1967; 100 (3) 185-191
    CrossrefPubMedGoogle Scholar