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. 1993 Sep 25;307(6907):761–764. doi: 10.1136/bmj.307.6907.761

Investigation of urinary tract infection in childhood.

L Jadresic 1, K Cartwright 1, N Cowie 1, B Witcombe 1, D Stevens 1
PMCID: PMC1696421  PMID: 8219946

Abstract

OBJECTIVES--To determine the number of laboratory confirmed urinary tract infections in children and to ascertain general practitioners' practices and attitudes towards their investigation and management. DESIGN--Prospective one year survey of urine specimens submitted for bacteriological investigation; review of radiology department records; questionnaire survey of general practitioners. SETTING--Gloucester health district. SUBJECTS--57,432 children aged < 15 and 7143 children aged < 2 registered with a general practice in Gloucester health district and their 195 general practitioners. RESULTS--4317 urine specimens were submitted from children aged < 15, of which 563 from 442 children were culture positive. The rate (number/100 children/practice) of culture positive urine specimens in these children varied more than 10-fold between general practices, and this correlated closely with the rate of referral of urine specimens for investigation. A follow up specimen to check for clearance of infection was taken in 22% (125/563) of infections. Of the 821 specimens submitted from children aged < 2, 103 from 89 children were positive. Of these children, 28 underwent radiological imaging. Most general practitioners would aim to obtain bacteriological confirmation of urinary tract infection on weekdays but only a minority said they would do so at weekends. They were apparently more likely to refer boys and younger children for renal tract imaging after a first urinary tract infection. CONCLUSIONS--Urinary tract infection in children was underdiagnosed, and after a confirmed infection only a minority of patients received renal tract imaging or microbiological follow up. Greater awareness of the importance of investigation and management of urinary tract infection in children is needed, and the practical difficulties faced by general practitioners must be resolved.

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Selected References

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  1. Berg U. B., Johansson S. B. Age as a main determinant of renal functional damage in urinary tract infection. Arch Dis Child. 1983 Dec;58(12):963–969. doi: 10.1136/adc.58.12.963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ditchburn R. K., Ditchburn J. S. A study of microscopical and chemical tests for the rapid diagnosis of urinary tract infections in general practice. Br J Gen Pract. 1990 Oct;40(339):406–408. [PMC free article] [PubMed] [Google Scholar]
  3. Ferguson-Smith M. A., North M. A., Affara N. A., Briggs H. The secret of sex. Lancet. 1990 Sep 29;336(8718):809–810. doi: 10.1016/0140-6736(90)93270-y. [DOI] [PubMed] [Google Scholar]
  4. Filly R., Friedland G. W., Govan D. E., Fair W. R. Development and progression of clubbing and scarring in children with recurrent urinary tract infections. Radiology. 1974 Oct;113(1):145–153. doi: 10.1148/113.1.145. [DOI] [PubMed] [Google Scholar]
  5. HODSON C. J., EDWARDS D. Chronic pyelonephritis and vesico-ureteric reflex. Clin Radiol. 1960 Oct;11:219–231. doi: 10.1016/s0009-9260(60)80047-5. [DOI] [PubMed] [Google Scholar]
  6. KASS E. H. Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. AMA Arch Intern Med. 1957 Nov;100(5):709–714. doi: 10.1001/archinte.1957.00260110025004. [DOI] [PubMed] [Google Scholar]
  7. Littlewood J. M. 66 infants with urinary tract infection in first month of life. Arch Dis Child. 1972 Apr;47(252):218–226. doi: 10.1136/adc.47.252.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. SMELLIE J. M., HODSON C. J., EDWARDS D., NORMAND I. C. CLINICAL AND RADIOLOGICAL FEATURES OF URINARY INFECTION IN CHILDHOOD. Br Med J. 1964 Nov 14;2(5419):1222–1226. doi: 10.1136/bmj.2.5419.1222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Smellie J. M., Ransley P. G., Normand I. C., Prescod N., Edwards D. Development of new renal scars: a collaborative study. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1957–1960. doi: 10.1136/bmj.290.6486.1957. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Smellie J., Edwards D., Hunter N., Normand I. C., Prescod N. Vesico-ureteric reflux and renal scarring. Kidney Int Suppl. 1975 Aug;4:S65–S72. [PubMed] [Google Scholar]
  11. Verrier Jones K. Antimicrobial treatment for urinary tract infections. Arch Dis Child. 1990 Mar;65(3):327–330. doi: 10.1136/adc.65.3.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Vickers D., Ahmad T., Coulthard M. G. Diagnosis of urinary tract infection in children: fresh urine microscopy or culture? Lancet. 1991 Sep 28;338(8770):767–770. doi: 10.1016/0140-6736(91)90662-9. [DOI] [PubMed] [Google Scholar]
  13. White R. H. Management of urinary tract infection. Arch Dis Child. 1987 Apr;62(4):421–427. doi: 10.1136/adc.62.4.421. [DOI] [PMC free article] [PubMed] [Google Scholar]

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