Update of the EAU/ESPU guidelines on urinary tract infections in children

Introduction/background Urinary tract infections (UTIs) are common in chil-dren and require appropriate diagnostic evaluation, management and follow-up. Objective To provide a summary of the updated European As-sociation of Urology (EAU) guidelines on Pediatric Urology, which were first published in 2015 in Euro-pean Urology. Study design A structured literature review was performed of new publications between 2015 and 2020 for UTIs in children. The guideline was updated accordingly with relevant new literature. Results The occurrence of a UTI can be the first indication of anatomical abnormalities in the urinary tract, especially in patients with a febrile UTI. The basic diagnostic evaluation should include sufficientinvestigations to exclude urinary tract abnormal-ities, but should also be as minimally invasive as possible. In recent years, more risk factors have been identified to predict the presence of these anatomical anomalies, such as a non-E. Coli infec-tion, high grade fever and ultrasound abnormalities. When these risk factors are factored into the diag-nostic work-up, some invasive investigations can be omitted in a larger group of children. In addition to the treatment of active UTIs, it is also essential to prevent recurrent UTIs and conse-quent renal scarring. With the increase of antimi-crobial resistance good antibiotic stewardship is needed. In addition, alternative preventative mea -sures such as dietary supplements, bladder and bowel management and antibiotic prophylaxis could decrease the incidence of recurrent UTI. Conclusion This paper is a summary of the updated 2021 EAU guidelines on Pediatric Urology. It provides practical considerations and flowcharts for the management and diagnostic evaluation of UTIs in children.