• nephrology
• microbiology

Urinary tract infections (UTIs) are among the most common bacterial infection in childhood. Young infants are at particular risk of serious infection or sepsis if UTI is not recognised, and delay in initiating appropriate antibiotics has been associated with an increased risk of pyelonephritis or renal scarring regardless of whether a child has vesico-ureteric reflux or not.1 Making a reliable diagnosis of UTI can be challenging, in particular in young pre-continent children. Whichever urine collection method is chosen, non-invasive (clean catch, nappy pad or bag) or invasive (suprapubic aspiration or catheter insertion), obtaining a clean specimen is critical, as the gold standard for diagnosis of UTI is growth of pathogenic bacteria in sufficient number in an uncontaminated urine sample. The National Institute for Health and Care Excellence (NICE) CG54 guideline states that infants and children presenting within 24 hours with unexplained fever of ≥38°C and/or urinary symptoms should have a urine sample tested. While clean sampling methods are preferred, NICE does, as one of very few countries globally, still accommodate for nappy pad collection for UTI diagnosis, as long as the manufacturer’s instructions are followed.

The reality on the ground looks different. Two recent audits from acute paediatric departments in the North East of England with a total of 178 …