Urinary sepsis in children: a systematic review of diagnostic and therapeutic aspects Infecção urinária em crianças: uma revisão sistemática dos aspectos diagnósticos e terapêuticos

During the last decade, new imaging techniques and biological probes provided further insight into the pathogenesis and natural history of urinary tract infection (UTI) in children. Especially in newborns, UTI is a common cause of fever and probably the most common cause of renal parenchymal loss. In children aged equal or less than 2 years, the symptoms of UTI are vague and non-specific - fever, irritability, poor feeding, vomiting, diarrhea and ill appearance. In neonates, clinical symptoms or laboratory tests could not be used to predict UTI episodes or eliminate the likelihood of a UTI even if other sites of infections are clinically suggested. For this reason, the goal of managing UTI in children is based on identifying and modifying factors that may increase the risk of renal parenchymal and functional loss as from the onset of infection. Moreover, selective antimicrobial pressure is a major concern when treating children with UTI, as renal parenchymal loss may occur within a short period of time, if inadequate antimicrobial agents are utilized. OBJECTIVES: This systematic review assessed recent diagnostic and therapeutic aspects of severe UTI in children. We also summarized wellconducted studies and the most important publications regarding diagnosis and treatment of urinary sepsis in the pediatric population. SEARCH STRATEGY: Trials and reviews were searched in general and specialized databases (MEDLINE, Cochrane Library) and references were reviewed. SELECTION CRITERIA: All published trials and reviews were eligible for inclusion provided they reported results for the pediatric population, included clinically significant events resulting from urinary tract infection, and included specific aspects of diagnosis and therapy. DATA COLLECTION: One reviewer extracted Information. Diagnostic and therapeutic aspects of urinary sepsis in the pediatric age group were assessed.