American Academy of Pediatrics Section on Urology
View all recommendations from this societyReleased January 4, 2022
Do not screen for urinary tract infection in asymptomatic patients who perform clean intermittent catheterization.
Guidance has been published by the American Urological Association (AUA), European Association of Urology (EAU), and the Infectious Diseases Society of America (IDSA) that discourage both the screening for and treatment of asymptomatic bacteriuria (ASB) in non-pregnant patients, including children. Children who perform clean intermittent catheterization may have urinary tract colonization of bacteria sometimes considered to be pathogenic. Typical symptoms of UTI include fever, chills, and/or pain (dysuria, abdominal, flank, suprapubic). Urinary consistency changes, such as cloudy urine, odor, or sediment are commonly described, but when in isolation, can be normal based on hydration and emptying. Atypical symptoms of UTI can include malaise, lethargy, and anorexia.
In children with neurological abnormalities, such as those with neurogenic bladder, UTIs may present with atypical symptoms; however, these symptoms should also prompt providers to assess for constipation and other systemic pathologies.
Low-grade fever and pyuria in the absence of any other UTI symptoms does not necessarily indicate urinary infection, so clinicians must carefully exclude other sources of fever. A multitude of studies have concluded that the treatment of ASB contributes to the widespread problem of resistant bacterial strains.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The AAP Section on Urology (AAP SOU) Executive committee worked together to develop five items in the practice of Pediatric Urology of tests or procedures that should not be done routinely. Approximately 11 members of this committee participated in the process. They submitted items from their practices and experiences of tests or procedures they found were commonly over-utilized. The committee then agreed on a final list of 5 based on incidence and importance of the condition. Educational committee fellows then reviewed the appropriate guidelines and literature to provide references and support for each item. The AAP SOU Education committee reviewed the 5 listed items and provided further feedback then approved the list, descriptions, and references. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Averch T, Stoffel J, Goldman HB, et al. Catheter-Associated Urinary Tract Infections: Definitions and Significance in the Urologic Patient. 2014 White Paper Guidelines [online]. American Urological Association. Available at: https://www.auanet.org/guidelines/catheter-associated-urinary-tract-infections [Accessed 20 Nov 2019].
Nicolle LE, Gupta K, Bradley SF, et al: Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May:50: 83-110.
Grabe M, Bartoletti R, Bjerklund Johansen TE, et al: European Association of Urology: Guidelines on Urological Infections. 2015 Mar.
Gerber D, Forster CS, Hsieh M: The Role of the Genitourinary Microbiome in Pediatric Urology: a Review. Curr Urol Rep. 2018 Nov:19(1): 13.
