General practitioners ‘may miss UTI in children’

By Caroline Price, Senior medwireNews Reporter

Family doctors need to lower their threshold of suspicion for urinary tract infection (UTI) in children, according to UK research.

The study suggested that general practitioners (GPs) will miss many cases if they rely on their own suspicion or refer to the guidelines to decide whether urinary sampling is needed.

Writing in the British Journal of General Practice, the authors say: "The current strategy of suspicion-led urine sampling is likely to miss the majority of cases of UTI, along with the opportunity to treat promptly, and hence minimize morbidity and possibly reduce the risk of future complications."

Even children who do not develop fever with a UTI or in whom the infection is self-limiting may be prone to develop renal scarring, the researchers point out.

In a study of 1003 children aged under 5 years, recruited over a 2-year period at 13 general practices, the team found that 5.9% of the 597 children who underwent urinary sampling within 2 days turned out to have a UTI.

The prevalence was higher among those under the age of 3 years, at 7.3%, compared with 3.2% in 3-5-year-olds.

Multivariable analysis revealed that a history of being hot or feverish or of abdominal pain or vomiting, or a family history of UTI or kidney problems, were not associated with UTI.

An alternative source of infection (upper or lower respiratory tract, tonsillitis, gastroenteritis, conjunctivitis, or otitis) also did not rule out UTI.

On the other hand, age under 3 months, pain or crying on passing urine, and increased urinary frequency or frequency of wet nappies, were all independent predictors for UTI.

Based on a 'working diagnosis' recorded by GPs at the initial consultation, the researchers say that relying on GPs' suspicion to guide urinary sampling would have led to 80% of cases being missed.

Furthermore, even assuming current UK NICE (National Institute for Health and Clinical Excellence) guidelines - which recommend urinary sampling based on the presence of fever or absence of any alternative possible infection - were applied, 51% of cases would have been missed.

Kathryn O'Brien (University of Cardiff) and team conclude: "The probability of UTI in children under the age of 3 years is reasonably high, irrespective of the presenting symptoms and signs. Larger studies are needed, but a lower threshold for urine sampling in young children appears to be indicated."

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