"We found only two small studies that support aggressive testing for urinary tract infections (UTIs) in febrile infants to prevent long-term kidney problems, while the rest of the medical literature has been unable to link UTIs to these complications," said lead author David Newman, MD, of the Mount Sinai School of Medicine in New York, NY. ""Bladder catheterization is painful, invasive and stressful and has the potential to cause infection. We could not find sufficient justification for doing it in our review, particularly in view of the considerable negative effects."
Aggressive testing in infants for UTIs has been justified in order to prevent and/or treat urosepsis. However, Dr. Newman and his team found data suggesting that urosepsis in the pediatric population is rare, generally less life-threatening than other types of sepsis, and typically limited to a well-defined population of newborns with congenital anomalies.
Aggressive testing in infants has also been justified to prevent kidney infection and subsequent scarring. Dr. Newman and his team found no evidence supporting the notion that kidney scarring results in clinically significant long-term kidney dysfunction.
"Since vaccine advances, rates of pediatric bacteremia, meningitis and related sepsis have decreased dramatically, and pediatric urosepsis remains exceedingly rare," said Dr. Newman. "We recommend re-examining the guidelines that recommend aggressive testing of feverish infants for UTIs, as we could not find long-term justification for it. Watching and waiting may be a better approach than putting babies - and their parents - through the discomfort of catheterization."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
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