Ambulatory Management of Urinary Tract Infections in Children: Experience of the Pediatric Medical Emergency Department in Rabat

Abstract

The aim of the study is to describe the clinical epidemiological characteristics and bacteriological profile of UTIs in infants and children, to determine the main risk factors for the occurrence of UTIs, and to identify the causes of UTIs urinary tract infections, to compare the interest of CRP and let procalcitonin assays for the diagnosis of febrile urinary tract infections as well as the interest of imaging (renal scintigraphy and ultrasound of the urinary tree) in the diagnosis of febrile urinary tract infections. This observational study of a cohort of 169 patients (children aged more than 28 days, 119 girls and 40 boys) conducted in the pediatric emergency department of the children's hospital of the university hospital of Rabat over a period of 6 months. The diagnosis of UTIs is based on the detection of germs in the urine, either indirectly by urine dipstick or by urine culture. However, the interpretation of microbiological results can be tricky: an inappropriate urine collection technique, particularly in neonates and young children, is a pitfall that the clinician must take into account to avoid misdiagnosing UTI, usually by over-diagnosis. The location of high UTI involving the renal parenchyma or low UTI limited to the bladder, which determines the morbidity of the infection, the therapeutic management and the imaging work-up, remains a matter of debate. DMSA renal scintigraphy, the reference examination in the case of high UTI, cannot be recommended as a first-line examination because of its cost and the practical difficulties of performing it. Biological markers of inflammation (leucocytosis, CRP, procalcitonin) do not always allow the diagnosis of ANP to be made with certainty.