Article Text
Abstract
Background Imaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coli is considered high risk in many national guidelines, but evidence is mainly drawn from small cohorts from tertiary centres.
Objective To ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >100 000 cfu per ml) in primary care or an emergency department without admission stratified by bacteria type.
Design, setting, patients Data were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months.
Results 7730 children (79% girls, 16% aged <1 year, 55% 1–4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%). E. coli UTI yielded abnormal kidney imaging in 8.9% (566/6384). Enterococcus and KPP (Klebsiella, Proteus, Pseudomonas) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality.
Conclusion In this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non-E. coli UTI was not associated with a higher yield from renal tract imaging.
- Emergency Care
- Microbiology
- Primary Health Care
- Nephrology
- Infectious Disease Medicine
Data availability statement
Data are available upon reasonable request. On reasonable request aggregated non patient identifiable data can be shared.
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Data availability statement
Data are available upon reasonable request. On reasonable request aggregated non patient identifiable data can be shared.
Footnotes
Twitter @YincentTse, @owens_stephen
Contributors YT conceived the article, produced the initial draft and is acting as the guarantor; CP, manual search ICE data. All authors with their different skills and unique perspective inputted into initial draft, revised and approved the final article. Since 2022, YT has been the service lead for the Newcastle Direct Access UTI service.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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