Prevalence of urinary tract infection (UTI) in sequential acutely unwell children presenting in primary care: Exploratory study

Abstract

Background. Due to the non-specific nature of symptoms of UTI in children and low levels of urine sampling, the prevalence of UTI amongst acutely ill children in primary care is unknown. Objectives. To undertake an exploratory study of acutely ill children consulting in primary care, determine the feasibility of obtaining urine samples, and describe presenting symptoms and signs, and the proportion with UTI. Design. Exploratory, observational study. Setting. Four general practices in South Wales. Subjects. A total of 99 sequential attendees with acute illness aged less than five years. Main outcome measure. UTI defined by >10⁵ organisms/ml on laboratory culture of urine. Results. Urine samples were obtained in 75 (76%) children. Three (4%) met microbiological criteria for UTI. GPs indicated they would not normally have obtained urine samples in any of these three children. However, all had received antibiotics for suspected alternative infections. Conclusion. Urine sample collection is feasible from the majority of acutely ill children in primary care, including infants. Some cases of UTI may be missed if children thought to have an alternative site of infection are excluded from urine sampling. A larger study is needed to more accurately determine the prevalence of UTI in children consulting with acute illness in primary care, and to explore which symptoms and signs might help clinicians effectively target urine sampling.

Key Words::

• Children
• diagnosis
• prevalence
• primary care
• urinary tract infection

Acknowledgements

The authors would like to thank the parents of the children, the general practitioners, nurses, and practice staff for participating in the study.

Statement of financial support for the reported project

Cardiff University funded the project. The WORD (Welsh Office of Research and Development) funded South East Wales Trials Unit (SEWTU) and the Wales School of Primary care Research supported the study.

Ethics approval

Ethical approval for the study was obtained from the South East Wales Local Research Ethics committee (ref no.06/WSE03/117). Informed, written consent was obtained from all participants.

Competing interests

None.