title: Acute pyelonephritis in children.
abstract: Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.
authors.affiliation: Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Via Massarenti 11, 40138, Bologna, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Morello
authors.affiliation: Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Via Massarenti 11, 40138, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: La Scola
authors.affiliation: Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Via Massarenti 11, 40138, Bologna, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Alberici
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Department of Clinical Sciences and Community Health, University of Milan Fondazione IRCCS Cà Granda -Ospedale Maggiore Policlinico Via della Commenda, 9 20122, Milano, Italy. giovanni.montini@unimi.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D002648:Child; D006801:Humans; D007223:Infant; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute pyelonephritis; Antibiotic prophylaxis; Antibiotic resistance; Guidelines; Urinary tract infections; Vesicoureteral reflux