Childhood urinary tract infection in primary care: A prospective observational study of prevalence, diagnosis, treatment, and recovery - Abstract

BACKGROUND: The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown.

AIM: To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery.

DESIGN AND SETTING: Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales.

METHOD: Systematic urine sampling from children aged < 5 years presenting in primary care with acute illness with culture in NHS laboratories.

RESULTS: Of 6079 children's urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, P< 0.001). Of 231 children with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; P< 0.001). Children with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005).

CONCLUSION: Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism's sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed.

Written by:
Butler CC, O'Brien K, Pickles T, Hood K, Wootton M, Howe R, Waldron CA, Thomas-Jones E, Hollingworth W, Little P, Van Der Voort J, Dudley J, Rumsby K, Downing H, Harman K, Hay AD.   Are you the author?
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; Cochrane Institute of Primary Care and Public Health; South East Wales Trials Unit, Cardiff University, Cardiff; Specialist Antimicrobial Chemotherapy Unit; School of Social and Community Medicine; Primary Care and Population Sciences Division, University of Southampton, Southampton; Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff; Bristol Royal Hospital for Children, Bristol; Centre for Academic Primary Care, University of Bristol, Bristol.

Reference: Br J Gen Pract. 2015 Apr;65(633):e217-23.
doi: 10.3399/bjgp15X684361

PubMed Abstract
PMID: 25824181 Infections Section