Tailoring discharge planning after pediatric febrile urinary tract infection: a cohort study

Febrile urinary tract infections (fUTIs) are a common cause of hospitalization in children and may recur in predisposed patients. Although current recommendations define indications for imaging and specialist referral, limited guidance is available to help hospital pediatricians identify, during hospitalization, children with clinical features associated with recurrent fUTI and tailor discharge planning accordingly. We conducted a retrospective, nationwide Italian cohort study including children aged 2 months to 3 years who were hospitalized for fUTI. Routinely collected clinical, laboratory, microbiological and imaging data were analyzed. Patients were stratified by sex and by the presence or absence of previously diagnosed congenital anomalies of the kidney and urinary tract (CAKUT). Adjusted multivariable logistic regression analyses were performed to identify factors associated with recurrent fUTIs. A total of 570 children were included, with a median age of 0.55 years. In the overall cohort, recurrent fUTIs were independently associated with older age, previously diagnosed CAKUT, acute kidney injury (AKI), and hydronephrosis with anterior-posterior diameter of the pelvis 5-15 mm. Among males with previously diagnosed CAKUT, recurrent fUTIs were independently associated with phimosis. Among males without previously diagnosed CAKUT, they were independently associated with AKI and non-E. coli infection. Among females, AKI was independently associated with recurrent fUTIs regardless of CAKUT status. CONCLUSIONS: In children hospitalized for fUTIs, readily available clinical, laboratory, microbiological, and imaging findings are associated with recurrent fUTIs. Considering these elements during hospitalization may help hospital pediatricians identify children who may benefit from targeted interventions and tailored discharge planning. WHAT IS KNOWN: • Current Italian recommendations provide guidance on imaging and specialist referral after pediatric febrile urinary tract infection (fUTI) but offer limited guidance for discharge planning. • Several clinical factors are associated with recurrent fUTI. WHAT IS NEW: • In boys, recurrent fUTIs were independently associated with phimosis in those with known CAKUT and with AKI and non-E. coli infection in those without known CAKUT, whereas in girls AKI was the only independent factor regardless of CAKUT status. • These findings were translated into a practical framework to support tailored discharge planning for hospital pediatricians.