Prevalence of urinary tract infection (UTI) in sequential acutely unwell children presenting in primary care:
Kathryn O'Brien1, Naomi Stanton, Adrian Edwards
1The Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, UK. obrienka@cf.ac.uk
Insights
Collecting urine samples from acutely ill children in primary care is feasible. However, some urinary tract infections (UTIs) may be missed if not specifically tested for, highlighting the need for further research.
Area of Science:
- Pediatric primary care research
- Infectious disease diagnostics
Background:
- Prevalence of urinary tract infections (UTIs) in acutely ill children in primary care is unknown due to non-specific symptoms and low urine sampling rates.
- Accurate diagnosis of UTI in children is crucial for appropriate treatment and preventing complications.
Purpose of the Study:
- To assess the feasibility of obtaining urine samples from acutely ill children in primary care.
- To describe presenting symptoms and signs in this population.
- To determine the proportion of children with a confirmed UTI.
Main Methods:
- Exploratory, observational study conducted in four general practices in South Wales.
- 99 sequential children under five years with acute illness were recruited.
- Urinary tract infection (UTI) was defined by laboratory culture yielding >10^5 organisms/ml of urine.
Main Results:
- Urine samples were successfully obtained from 75% (76) of children.
- 3% (4) of children met the microbiological criteria for a urinary tract infection (UTI).
- GPs would not have routinely sampled urine in these cases, and all received antibiotics for other suspected infections.
Conclusions:
- Urine sample collection is feasible in most acutely ill children presenting to primary care, including infants.
- Excluding children with suspected alternative infections from urine sampling may lead to missed UTI diagnoses.
- A larger study is required to accurately determine UTI prevalence and identify clinical indicators for targeted urine sampling in children.
Background:
Due to the non-specific nature of symptoms of UTI in children and low levels of urine sampling, the prevalence of UTI amongst acutely ill children in primary care is unknown.
Objectives:
To undertake an exploratory study of acutely ill children consulting in primary care, determine the feasibility of obtaining urine samples, and describe presenting symptoms and signs, and the proportion with UTI.
Design:
Exploratory, observational study.
Setting:
Four general practices in South Wales.
Subjects:
A total of 99 sequential attendees with acute illness aged less than five years.
Main Outcome Measure:
UTI defined by >10(5) organisms/ml on laboratory culture of urine.
Results:
Urine samples were obtained in 75 (76%) children. Three (4%) met microbiological criteria for UTI. GPs indicated they would not normally have obtained urine samples in any of these three children. However, all had received antibiotics for suspected alternative infections.
Conclusion:
Urine sample collection is feasible from the majority of acutely ill children in primary care, including infants. Some cases of UTI may be missed if children thought to have an alternative site of infection are excluded from urine sampling. A larger study is needed to more accurately determine the prevalence of UTI in children consulting with acute illness in primary care, and to explore which symptoms and signs might help clinicians effectively target urine sampling.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:27Acute Pyelonephritis I: Introduction
01:28Acute Pyelonephritis II: Diagnostic Studies and Management