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Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with
Kathryn O'Brien1, Adrian Edwards, Kerenza Hood
1Cochrane Institute of Primary Care and Public Health, UK. obrienka@cardiff.ac.uk
Insights
Approximately 6% of young children presenting with acute illness have a urinary tract infection (UTI). Current guidelines may miss half of these infections, suggesting a lower threshold for urine sampling in children is needed.
Area of Science:
- Pediatrics
- Infectious Diseases
- General Practice
Background:
- Urinary tract infections (UTIs) in children can lead to serious long-term complications if not treated promptly.
- Early detection and management of pediatric UTIs are crucial for preventing adverse outcomes.
Purpose of the Study:
- To determine the prevalence of UTIs in acutely ill children aged 5 years and younger presenting to general practices.
- To analyze presenting symptoms and evaluate urine sampling strategies for diagnosing UTIs in this age group.
Main Methods:
- A prospective observational study was conducted in 13 general practices in Wales, UK.
- 1003 children were recruited, with systematic urine sampling performed.
- Multivariable analysis was used to identify factors associated with UTI probability.
Main Results:
- The overall prevalence of UTI was 5.9%, higher in children under 3 years (7.3%) than in 3-5 year olds (3.2%).
- Fever history or absence of an alternative infection source did not reliably predict UTI.
- Current guideline-based sampling strategies could miss up to 50% of UTIs, while GP suspicion alone could miss 80%.
Conclusions:
- Nearly 6% of acutely unwell young children in UK general practice settings are diagnosed with a UTI.
- The study highlights a higher-than-expected UTI prevalence, advocating for increased clinician awareness and a lower threshold for urine sampling.
- Clinical signs like fever or presence of alternative infections may not be sufficient to rule out UTI in young children.
Background:
Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment.
Aim:
To determine the prevalence of UTI in acutely ill children ≤ 5 years presenting in general practice and to explore patterns of presenting symptoms and urine sampling strategies.
Design And Setting:
Prospective observational study with systematic urine sampling, in general practices in Wales, UK.
Method:
In total, 1003 children were recruited from 13 general practices between March 2008 and July 2010. The prevalence of UTI was determined and multivariable analysis performed to determine the probability of UTI.
Result:
Out of 597 (60.0%) children who provided urine samples within 2 days, the prevalence of UTI was 5.9% (95% confidence interval [CI] = 4.3% to 8.0%) overall, 7.3% in those < 3 years and 3.2% in 3-5 year olds. Neither a history of fever nor the absence of an alternative source of infection was associated with UTI (P = 0.64; P = 0.69, respectively). The probability of UTI in children aged ≥3 years without increased urinary frequency or dysuria was 2%. The probability of UTI was ≥5% in all other groups. Urine sampling based purely on GP suspicion would have missed 80% of UTIs, while a sampling strategy based on current guidelines would have missed 50%.
Conclusion:
Approximately 6% of acutely unwell children presenting to UK general practice met the criteria for a laboratory diagnosis of UTI. This higher than previously recognised prior probability of UTI warrants raised awareness of the condition and suggests clinicians should lower their threshold for urine sampling in young children. The absence of fever or presence of an alternative source of infection, as emphasised in current guidelines, may not rule out UTI in young children with adequate certainty.
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