Longer Time to Pediatric UTI Treatment Linked to Renal Scarring

By Anne Harding

NEW YORK - Delaying antibiotic treatment for pediatric febrile urinary tract infection (UTI) is associated with an increased risk of renal scarring, according to new findings in JAMA Pediatrics.

"In febrile children, clinicians should not delay testing for UTI," Dr. Nader Shaikh of Children's Hospital of Pittsburgh of UPMC and colleagues state in their report, published online July 25.

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Some studies suggest that delaying treatment of febrile UTIs in pediatric patients is associated with greater extent or severity of renal scarring, the researchers note. To investigate, they looked at data on 482 children with UTIs from the Randomized Intervention for Children with Vesicoureteral Reflux trial and the Careful Urinary Tract Evaluation Study. Thirty-five children (7.2%) developed renal scarring.

The median delay in initiation of antimicrobial therapy was 72 hours for the children with renal scarring, while it was 48 hours for the children without renal scarring (P=0.003).

Other factors associated with an increased risk of scarring included older age (odds ratio 1.03), Hispanic ethnicity (OR 5.24), recurrent UTIs (OR 0.97), and bladder and bowel dysfunction (OR 6.44).

"A growing body of evidence suggests that delay in treatment of febrile UTIs and permanent renal scarring are associated," Dr. Shaikh and colleagues state. "These data may help clinicians make more informed decisions regarding the need for diagnostic testing for UTIs in children with fever."

Dr. Shaikh did not respond to an interview request by press time.

Dr. Debra Palazzi of Baylor College of Medicine and Texas Children's Hospital in Houston, who cowrote an editorial with Dr. Lucila Marquez, told Reuters Health in a phone interview, "The recommendations from the American Academy of Pediatrics are in line with what the authors of the study are saying, and what they found. It's always been stated that when urinary tract infection is suspected, you should perform appropriate studies and initiate antimicrobial therapy promptly. I don't think this changes that, it just brings to light that timing could be important."

For children in whom UTI is suspected, Dr. Palazzi added, it's important to begin treatment promptly and then continue therapy if testing confirms the UTI. "The culture will really help guide appropriate therapy," she said.

SOURCE: https://bit.ly/2a9AebN and https://bit.ly/2a9zPpT

JAMA Pediatrics 2016.

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