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

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery
Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery
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 <5years 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.
0960-1643
e217-e223
Butler, Christopher C
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O'Brien, Kathryn
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Pickles, Timothy
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Hood, Kerenza
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Wootton, Mandy
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Howe, Robin
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Waldron, Cherry-Ann
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Thomas-Jones, Emma
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Hollingworth, William
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Little, Paul
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Van Der Voort, Judith
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Dudley, Jan
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Rumsby, Kate
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Downing, Harriet
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Harman, Kim
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Hay, Alastair D.
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Butler, Christopher C
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O'Brien, Kathryn
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Pickles, Timothy
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Hood, Kerenza
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Wootton, Mandy
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Howe, Robin
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Waldron, Cherry-Ann
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Thomas-Jones, Emma
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Hollingworth, William
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Little, Paul
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Van Der Voort, Judith
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Dudley, Jan
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Rumsby, Kate
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Downing, Harriet
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Harman, Kim
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Hay, Alastair D.
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Butler, Christopher C, O'Brien, Kathryn, Pickles, Timothy, Hood, Kerenza, Wootton, Mandy, Howe, Robin, Waldron, Cherry-Ann, Thomas-Jones, Emma, Hollingworth, William, Little, Paul, Van Der Voort, Judith, Dudley, Jan, Rumsby, Kate, Downing, Harriet, Harman, Kim and Hay, Alastair D. (2015) Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery. British Journal of General Practice, 65 (633), e217-e223. (doi:10.3399/bjgp15X684361). (PMID:25824176)

Record type: Article

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 <5years 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.

Full text not available from this repository.

More information

Accepted/In Press date: 30 September 2014
Published date: 1 April 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 386036
URI: http://eprints.soton.ac.uk/id/eprint/386036
ISSN: 0960-1643
PURE UUID: ba3ee881-9e9c-4ab9-8ddb-4d6bcdb63cbc
ORCID for Kim Harman: ORCID iD orcid.org/0000-0002-5173-7753

Catalogue record

Date deposited: 18 Jan 2016 11:53
Last modified: 15 Jul 2019 20:50

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Contributors

Author: Christopher C Butler
Author: Kathryn O'Brien
Author: Timothy Pickles
Author: Kerenza Hood
Author: Mandy Wootton
Author: Robin Howe
Author: Cherry-Ann Waldron
Author: Emma Thomas-Jones
Author: William Hollingworth
Author: Paul Little
Author: Judith Van Der Voort
Author: Jan Dudley
Author: Kate Rumsby
Author: Harriet Downing
Author: Kim Harman ORCID iD
Author: Alastair D. Hay

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