Update and summary of the EAU/ESPU paediatric guidelines on urinary tract infection in children

BACKGROUND AND OBJECTIVE: These guidelines aim to provide a practical approach for both diagnosis and management of urinary tract infections (UTI). OBJECTIVE: To highlight 2025 update of the Guidelines of the European Association of Urology (EAU) and the European Society for Paediatric Urology (ESPU) on UTI in children. METHODS: A structured literature review was performed for all relevant litterature from the last update (2021) up to 20th February 2024. KEY FINDINGS AND LIMITATIONS: UTIs represent the most common bacterial infections in children. The leading causative organism is Escherichia Coli (E. Coli), however, other bacteria have been increasing in prevalence, as has the prevalence of multi-resistent E. Coli infections. UTIs can be classified in several ways including upper vs. lower urinary tract UTIs; febrile vs. non febrile UTIs; first vs. recurrent vs. breakthrough episode; typical vs. atypical. Urine samples for analysis can be collected by urine bag, clean catch, catheterization, or suprapubic aspiration. Methods for urinalysis include dipstick, microscopy and flow imaging analysis technology. Each collection and analysis method has its own advanatages and drawbacks. Microscopic urinalysis is recommended after a positive dipstick test. In terms of additional investigations, the Panel generally recommends a renal and bladder ultrasound after an initial febrile UTI, whereas additional investigations should be considered based on the characteristics of the patient and of the infection. A flow-chart is proposed. The cornerstone of UTI management is prompt antimicrobial therapy. The administration route should be chosen based on several variables. The agent should be chosen based on local antimicrobial sensitivity patterns, and adjusted according to sensitivity-testing. Interventions can be considered to prevent UTI recurrence including chemoprophylaxis, non-antibiotic prophylaxis, and treatment of phimosis, bladder-bowel dysfunction and lower urinary tract dysfunction. CONCLUSIONS AND CLINICAL IMPLICATIONS: This paper is a summary of the 2025 updated (Table) of EAU/ESPU Guidelines and provides practical considerations for the management and diagnostic evaluation of UTI in children.