Childhood UTI

The overall incidence of laboratory-proven urinary tract infection (UTI) (5.9%) and pre-sampling suspected UTI (>8%) among ‘acutely unwell children’ both seem, from my primary care experience, unusually high. The study suggests we are ‘missing’ about half of UTIs at first presentation, and concludes that we are under-treating UTIs. My own impression from my general medical clinic in secondary care is that we are over-diagnosing UTI and often over-treating as a result: primarily because of the diagnosis of UTI based exclusively on irritative symptoms alone. I would be interested to know, by way of a control, what the incidence of laboratory-confirmed UTI would be; using identical sampling among a matched group of well children. I suspect that the diagnostic criteria in the National Institute for Health and Care Excellence clinical guidance are appropriately broad so as to avoid missing those occasional cases of genuine clinically-significant infection that occur in the absence of pyuria, but which same criteria are, for the purposes of a research project proposing to measure the actual incidence of clinically significant infection, somewhat over-inclusive.