Diagnosis of urinary tract infections in the pediatric population – current practices, advances and progress

INTRODUCTION: One of the most controversial issues surrounding the management of urinary tract infection (UTI) in children remains that of diagnosis, which is paramount for successful therapeutics and overall management, due to lack of specific symptoms, sampling difficulties and debatable diagnostic criteria, all characteristics that differentiate pediatric from adult UTI. The current diagnostic strategy, based on urine culture, lacks specificity and entails considerable delay until the availability of the results. AREAS COVERED: This narrative review includes current diagnostics and their future perspectives with the integration of new technologies, novel host-based and pathogen-directed diagnostic methods and prediction models. Literature search was performed using Pubmed, focusing on recent publications about diagnostics of UTI and their use in children. EXPERT OPINION: Novel diagnostics include ultra-sensitive biosensors at point-of-care level and light-scattering, advanced microscopy and molecular techniques at laboratory level and have achieved reliable pathogen identification and provision of antibiotic susceptibility testing within hours instead of days. Less progress has been made in host-response approaches, based mostly on urine biomarkers, which nevertheless remain a promising field. Prediction models based on artificial intelligence (AI) methods are developing fast and with the combination of all information relevant to UTI can significantly contribute to individualized patient-tailored predictions.