Introduction The 2007 NICE guidelines on urinary tract infection1 (UTI) in children advised not to investigate children over 6 months with a typical first UTI. Birmingham Children’s Hospital (BCH) have continued to do a urinary tract ultrasound (USS) after the first UTI in children of all ages.
To define how many children have an abnormal USS after a first UTI and whether this affects their management
To see if urine samples were collected in a satisfactory manner
Methods A retrospective audit was completed to assess the rate of abnormalities diagnosed on USS in those who presented with a first UTI. The patients were identified by searching all who had USS Urinary Tracts for the indication of first UTI between January 2013 and October 2014. The USS results along with any further imaging done, follow up, culture results and methods of culture collection were collected. Abnormalities were graded according to a system used by Nelson et al2.
Results 151 patients had an USS after their first UTI. 32% of children had abnormal results; including 12 (8%) of children with the most serious abnormalities including moderate to severe hydronephrosis, renal scaring or atrophy. 36 (24%) had milder abnormalities including mild hydronephrosis and duplex kidneys. Of those with abnormalities 38% had some form of follow up imaging. Of the 12 patients with the most severe abnormalities, only 5 patients (3%) had active treatment including two who had antibiotics prophylaxis and three who had surgery.
There was a pure growth of E.coli in 67% of patients, 7% of patients had a non-E.coli growth, the rest had none or mixed growth, or no sample was sent. Urine was collected in a satisfactory manner in 94% of cases, including clean catch, in out catheter or a mid stream specimen.
Conclusions The practice of doing USS for the first UTI at BCH may be justified given the high incidence of urinary tract abnormalities found; however as only 3% of patients received active treatment this knowledge does not change management in the majority of patients.
NICE guideline CG54: Urinary tract infection in under 16s: diagnosis and management. Aug 2007
Nelson et al. Ultrasound as a screening test for genitourinary anomalies in Children with UTI. Pediatrics. 2014;133 (3):e394–e403
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