Which statement about pediatric urinary tract infections is not true?

Which statement about pediatric urinary tract infections is not true?

• A. Symptoms are nonspecific, especially in infancy
• B. Urine culture is required for definitive diagnosis
• C. Trimethoprim-sulfamethoxazole is a drug of choice for most children
• D. Radiologic studies are rarely indicated with first infection

Answer: (D)

Pediatric UTIs often present with nonspecific symptoms in infancy, so clinicians must have a high index of suspicion. To confirm infection, a urine culture is needed because dipstick results and symptoms alone aren’t reliable enough to diagnose UTI, especially in young children. Radiologic studies after a first febrile UTI are not rarely indicated. Guidelines support imaging to look for structural or functional issues in many cases, particularly in young children with a febrile infection. Renal and bladder ultrasound is commonly recommended after a first febrile UTI in children aged 2–24 months to detect anomalies, with voiding cystourethrogram reserved for abnormal ultrasound results or recurrent infections. Therefore, the statement that imaging is rarely indicated is incorrect.

Pediatric UTIs often present with nonspecific symptoms in infancy, so clinicians must have a high index of suspicion. To confirm infection, a urine culture is needed because dipstick results and symptoms alone aren’t reliable enough to diagnose UTI, especially in young children.

Radiologic studies after a first febrile UTI are not rarely indicated. Guidelines support imaging to look for structural or functional issues in many cases, particularly in young children with a febrile infection. Renal and bladder ultrasound is commonly recommended after a first febrile UTI in children aged 2–24 months to detect anomalies, with voiding cystourethrogram reserved for abnormal ultrasound results or recurrent infections. Therefore, the statement that imaging is rarely indicated is incorrect.