Restricted use of imaging after febrile urinary tract infection

January 01, 0001

Restricted use of imaging after febrile urinary tract infection

These US authors sought to determine the impact of using an algorithm requiring selective rather than routine urinary tract imaging following a first febrile urinary tract infection (UTI)in children under 2 years of age on imaging use, detection of vesicoureteral reflux (VUR), prophylactic antibiotic use, and UTI recurrence within 6 months. They conducted a retrospective review comparing outcomes during periods before algorithm use and after algorithm use. The new algorithm, which adapted recommendations from the United Kingdom's National Institute for Health and Clinical Excellence 2007 guidelines, was implemented in 2008. The algorithm calls for renal ultrasonography in most cases and restricts voiding cystourethrography for use in patients with certain risk factors.

They found: "After introduction of the new algorithm, voiding cystourethrography and prophylactic antibiotic use decreased markedly. Rates of UTI recurrence within 6 months and detection of grades 4 and 5 VUR did not change, but detection of grades 1 to 3 VUR decreased substantially. Patients in the prealgorithm group with grades 1 to 3 VUR who would have been missed with selective screening underwent no interventions other than successive urinary tract imaging and prophylactic antibiotic use."

The authors concluded: "By restricting urinary tract imaging after an initial febrile UTI, rates of voiding cystourethrography and prophylactic antibiotic use decreased substantially without increasing the risk of UTI recurrence within 6 months and without an apparent decrease in detection of high-grade VUR. Clinicians can be more judicious in their use of urinary tract imaging."

This is reasonably good evidence to restrict urinary tract imaging in young children.

For the full abstract, click here.

Arch Pediatr Adolesc Med 165(11):1027-1032, November 2011 © 2011 to the American Medical Association
Impact of a More Restrictive Approach to Urinary Tract Imaging After Febrile Urinary Tract Infection. Alan R. Schroeder, Jennifer M. Abidari, Rashmi Kirpekar, et al. Correspondence to Dr. Schroeder: Alan.Schroeder@hhs.sccgov.org

Category: U. Urinary. Keywords: urinary tract infection, children, infants, fever, imaging, guidelines, before and after study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 November 2011

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