Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study
Authors: Cenzato Francesca , Milani Gregorio P. , Amigoni Angela , Sperotto Francesca , Bianchetti Mario G. , Agostoni Carlo , Montini Giovanni ,   on behalf of the ItaUTI study group, Farello Giovanni , Chiarelli Francesco , Greco Rita , Di Lollo Franco , Rocco Forte Fabio , Manieri Sergio , Carpino Luigi , Caloiero Mimma , Cirisano Anastasia , Braghò Salvatore , Della Casa Roberto , Nunziata Felice , Pecoraro Carmine , Pacifico Rosario , Lanari Marcello , Ghizzi Chiara , Serra Laura , Stella Marcello , Maggiore Giuseppe , Fiorini Roberto , Dodi Icilio , Morelli Andrea , Lughetti Lorenzo , Cella Andrea , Vergine Gianluca , De Fanti Alessandro , Dragovic Danica , Santori Daniele , Cozzi Giorgio , Cogo Paola , Raponi Marilena , Lubrano Riccardo , de Martinis Mauro , Gatto Antonio , Barbieri Maria Antonietta , Reale Antonino , Bracaglia Giorgio , Piccotti Emanuela , Borea Riccardo , Gaiero Alberto , Martelli Laura , Arrighini Alberto , Cianci Paola , Cavalli Claudio , De Santis Leonardina , Pietra Benedetta Chiara , Biondi Andrea , Sala Marco , Pogliani Laura M. , Cherubini Simonetta , Bellini Marta , Bruni Paola , Traina Giovanni , Tommasi Paola , Del Barba Paolo , Arrigoni Sergio , Salvini Filippo M. , Bernardo Luca , Bertolozzi Giuseppe , Fasoli Silvia , Marseglia Gian Luigi , Palumbo Emilio , Bosco Annalisa , Mirri Gianpaolo , Fabiani Elisabetta , Ruffini Ermanno , Pieragostini Luisa , Fornaro Martina , Ripanti Gabriele , Pannoni Donnina , Enrico Felici , Perona Anna , Tappi Eleonora , Nis Haitink Oscar , Rabbone Ivana , Capalbo Pina Teresa , Urbino Antonio , Guala Andrea , Cosi Gianluca , Barracchia Maria Gabriella , Martire Baldassarre , Cardinale Fabio , Moramarco Fulvio , Perrone Carmelo , Campanozzi Angelo , Cecinati Valerio , Canetto Alessandro , Clemente Ciro , Cualbu Antonio , Narducci Fabio , Mula Giuseppina , Bulciolu Pasquale , Antonucci Roberto , Gramaglia Giuseppe , Cavaleri Giuseppe , Salpietro Carmelo , Corsello Giovanni , Salvo Rosario , Palmeri Marcello , Vitale Maria Assunta , Morgano Ambra , Falorni Susanna , Peroni Diego , Masi Stefano , Bertini Alessio , Vaccaro Angelina , Vasarri Pierluigi , Reinstadler Petra , Soffiati Massimo , Stefanelli Maurizio , Verrotti di Pianella Alberto , Bertone Catherine , Marzini Stefano , Da Dalt Liviana , Rugolotto Simone , Scozzola Floriana , Ecclesio Livio Luca , Cinquetti Mauro , Silvagni Davide , Bellettato Massimo 
Published: April 2022

Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. 

Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques.

What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting.

What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic CFU thresholds largely vary among centers.