The edition · Paediatrics
A positive urine culture without pyuria is not enough
The American Academy of Pediatrics' revised definition of urinary tract infection in young children makes pyuria a diagnostic criterion and sets culture thresholds by age and collection method. Plus resistance trends in children's infections to 2035, what screens are linked to, and which babies with congenital CMV need an eye exam.
The edition in brief
UTI definition: a technical report accompanying the 2026 American Academy of Pediatrics guideline for children aged 8 days to 5 years explains its revised definition. Pyuria is now a diagnostic criterion, with thresholds that differ by age and by whether culture results are available, and the culture threshold for a positive result now depends on age and how urine was collected. The aim is fewer over-diagnoses without more missed infections. Resistance: in 106,581 bacterial isolates from children in 82 countries between 2004 and 2022, resistance rose in every region and fastest in resource-limited settings. In intensive care, resistance to Watch-group antibiotics rose from 15% to 33%. Klebsiella resistance to cephalosporins and carbapenems rose fastest in regions including Southeast Asia, and carbapenem resistance is projected at 35% in Klebsiella and 82% in Acinetobacter by 2035. Screens: an umbrella review of 23 meta-analyses covering 2.8 million children found screen exposure associated with lower academic achievement and language skills and more emotional, peer and behavioural problems; most associations were small and none can show cause. Congenital CMV: of 347 Ontario infants identified by newborn screening who had eye examinations, only two had CMV-related eye findings, both already symptomatic; none of the asymptomatic infants did.
Resistance in children's infections rose everywhere, fastest in Gram-negatives and resource-limited settings
Guide empirical therapy by the local antibiogram and narrow it on culture results; resistance to Watch and Reserve drugs is rising fastest.
Screen use was linked to lower language skills and more emotional and peer problems
Counsel families on screen time as part of developmental care, particularly where language or behaviour is a concern.
Eye findings in screened congenital CMV appeared only in already symptomatic infants
Prioritise eye examination for symptomatic congenital CMV; routine examination of well, screen-detected infants yielded nothing here.
A bag urine can rule a UTI out, but not in
Confirm a suspected UTI with a clean-catch, catheter or suprapubic sample before treating; never diagnose on a bag culture.
AAP's revised UTI definition: pyuria becomes a criterion, and culture thresholds depend on age and sample
Require evidence of pyuria as well as a positive culture before diagnosing UTI in a young child, and read culture counts by age and collection method.
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