Abstract
Background : Urinary tract infection (UTI) is common among children. Management of UTI requires prompt diagnosis, treatment and most often, a regular follow up. Objectives : To evaluate compliance with the NICE guidelines 2007 when managing children aged 0 to16 years with bacteriologically proven UTI in a District General Hospital. Method: A descriptive retrospective study was carried out at Bronglais General Hospital, Aberystwyth, United Kingdom (UK) on children aged 0 to16 years with culture positive UTI from 1 st January 2012 to 31 st December 2014. Infants and children with urinary catheters in situ, pre-existing renal disorders and immune-suppression were excluded from the study. Patients were grouped into age categories to facilitate comparison of treatment and radiological investigations. Further categorisation was done according to NICE guidelines for urinary tract infection in children. Approval for the conduct of the audit was given by the Clinical Audit Department, Bronglais Hospital, UK. Ethical clearance for the study was obtained from the Ethical Review Committee of the Sri Lanka College of Paediatricians. Results : There were 104 children aged 0 to 16 years with culture proven UTI during the study period of whom 8 were excluded. Only 25% of infants 3 months old or less received intravenous (IV) antibiotics in compliance with the guidelines; 25% had only oral antibiotics and 50% had IV followed by oral antibiotics. For treatment of lower tract infection, duration of antibiotics prescription was longer than recommended. Overall adherence to investigations such as ultrasonography, dimercaptosuccinic acid scan and micturating cystourethrogram was 81%, 91% and 93% respectively. All children with recurrent UTIs were prescribed antibiotic prophylaxis adhering to NICE guidelines. Conclusions : Duration of antibiotic therapy in UTI was in compliance with NICE guidelines in 16-86% children. Radiological investigations were requested in UTI in compliance with NICE guidelines in 71-97% children. Prophylactic antibiotics were prescribed in UTI in compliance with NICE guidelines in 34-100% children.
Highlights
Urinary tract infections (UTIs) occur throughout childhood, with the highest frequency in infancy[1,2]
Duration of antibiotic therapy in UTI was in compliance with NICE guidelines in 16-86% children
Radiological investigations were requested in UTI in compliance with NICE guidelines in 7197% children
Summary
Urinary tract infections (UTIs) occur throughout childhood, with the highest frequency in infancy[1,2]. Following puberty its incidence increases in females but in males UTI remains uncommon[2]. Infections may involve both lower and upper urinary tracts. Management of UTI in infants and children requires follow up with appropriate radiological investigations[4,5]. According to Nice Guidelines 2007, antibiotic prophylaxis should not be routinely recommended in infants and children following a first-time UTI. It may be considered in infants and children with recurrent infections[5]. Urinary tract infection (UTI) is common among children. Management of UTI requires prompt diagnosis, treatment and most often, a regular follow up
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