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Original research
Low yield from imaging after non-E. coli urine tract infections in children treated in primary care and emergency department
  1. Yincent Tse1,2,
  2. Charlie Pickles1,
  3. Stephen Owens3,4,
  4. Michal Malina1,5,
  5. Richard Peace6,
  6. Milan Gopal7
  1. 1Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
  2. 2Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
  3. 3Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  5. 5Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  6. 6Department of Nuclear Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  7. 7Department of Paediatric Urology, Great North Children's Hospital, Newcastle upon Tyne, UK
  1. Correspondence to Dr Yincent Tse, Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, NE1 4LP, UK; yincenttse{at}nhs.net

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 >1 00 000 cfu) 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.

https://doi.org/10.1136/archdischild-2022-324930

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    Data availability statement

    Data are available upon reasonable request. On reasonable request aggregated non patient identifiable data can be shared.

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    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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.