Adherence to the Swedish paediatric guidelines for urinary tract infections

Area of Science:

• Pediatrics
• Infectious Diseases
• Urology

Background:

• Urinary tract infections (UTIs) are common in infants and require adherence to established guidelines for optimal management.
• Swedish pediatric guidelines provide a framework for the diagnosis, treatment, and imaging of UTIs in infants.
• Auditing adherence to these guidelines is crucial for ensuring quality of care and identifying areas for improvement.

Purpose of the Study:

• To audit adherence to Swedish pediatric guidelines for infant UTIs.
• To compare imaging findings obtained with and without guideline recommendations.
• To identify factors predicting non-adherence to UTI guidelines.

Main Methods:

• A prospective, multicenter study included 1357 infants under one year old treated for their first UTI.
• Adherence to diagnostic, treatment, and imaging recommendations was assessed over a one-year follow-up.
• Vesicoureteral reflux and renal scintigraphy findings were compared between guideline-adherent and non-adherent imaging.

Main Results:

• Adherence rates were 86.1% for diagnostics, 91.0% for antibiotic treatment, and 64.2% for imaging.
• Non-adherence to imaging was linked to inpatient care and smaller hospitals.
• Excessive imaging was more common than refrained imaging among non-adherent cases.

Conclusions:

• High adherence to UTI diagnosis and treatment guidelines suggests good clinical practice among pediatricians.
• Lower adherence to imaging guidelines, particularly early DMSA scans, highlights challenges for smaller hospitals and suggests potential guideline issues.
• Further refinement of imaging algorithms within UTI guidelines may be necessary, especially for resource-limited settings.