Audit on the diagnosis and management of childhood Urinary Tract Infections (UTIs)
Aim The aim of this audit was to assess the current practice of Urinary Tract Infection (UTI) diagnosis and treatment in A&E by evaluating the use of diagnostic UTI tests and adherence to local antibiotic1 and NICE2 3 guidelines. ⇓
Standards 1,2,3: 100% of ≤16-year-olds presenting with unexplained fever ≥38°C or signs and symptoms of UTI should have a urine sample taken. 100% of ≤3-year-olds with query UTI should have urine sent for microscopy and culture (M&C).
100% of <3-month-olds or between 3 month and 3 year with high/intermediate risk of UTI should have urine sent for urgent M&C.
100% of >3-year-olds with query UTI should have a urine dipstick.
100% of >3-year-olds with urine dipstick result nitrite and/or leukocyte positive should have urine sent for M&C.
100% of <3-month-olds and all children with raised creatinine, vomiting or sepsis should be prescribed IV ceftriaxone.
100% of ≤16-year-olds with a clinical diagnosis of cystitis or pyelonephritis should be prescribed PO cefalexin.
100% of ≤16-year-olds should be discharged without prophylactic antibiotic therapy.
Methods Standards were developed and agreed with the paediatric A&E consultant. The records of all patients ≤16 year whom presented to A&E with a diagnosis of ‘UTI’ or ‘query UTI’ during a 6-month period were obtained via the hospital's A&E admissions database. Data was collected retrospectively. Patients were excluded from the audit if they did not meet the inclusion criteria of the guidelines.1–3
Results Adherence to Audit Standards.
Conclusions Overall the standards were well adhered to, more so in the diagnostic process than with treatment.
Variance in clinical judgement and practice plays a large role in the diagnosis of childhood UTIs and as such, may account for non-adherence to guidelines when requesting tests.
Adherence to treatment guidelines is poor according to these results. It was not possible to ascertain reasons for deviation from protocol from the records. Clinical judgement over oral versus IV treatment may depend on other factors not measured by this audit. Adherence to antibiotic guidelines in this audit was extremely poor, highlighting the need for education and signposting in this area.
The UTI pro-forma in A&E is not routinely used. If this was re-launched it would aid practitioners in signposting the appropriate tests, and should refer to the Trust antibiotic guidelines.