title: Update on urinary tract infections in the emergency department.
abstract: OBJECTIVE
  To review recent changes in the diagnostic and therapeutic approach to pediatric urinary tract infection in the emergency department.
  
  
  RESULTS
  Updated guidelines from the American Academy of Pediatrics have significantly changed the approach to UTI, risk-stratifying patients according to their likelihood of UTI, and re-defining criteria for diagnosis of UTI. New studies have delineated important risk factors for concomitant bacteremia and adverse events. Procalcitonin has emerged as the inflammatory marker most predictive of upper versus lower urinary tract infection and renal scarring. Delays in empiric antibiotic therapy are associated with increased rates of renal scarring. Corticosteroids are a potential adjunctive therapy to antibiotics.
  
  
  CONCLUSIONS
  Timely diagnosis and therapy of UTI are essential. New guidelines may alter the traditional approach to evaluation and management. Future studies will likely focus on the impact of the new guidelines, further delineate the role of procalcitonin in predicting UTI, and explore the role of corticosteroids as an adjunct to antibiotic therapy.
authors: Division of Pediatric Emergency Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York 10021, USA. rak9043@med.cornell.edu
authors: Rachel H
authors: RH
authors: Kowalsky
authors: Nikhil B
authors: NB
authors: Shah
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D060085:Coinfection; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005938:Glucocorticoids