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Urinary tract infection in children: diagnosis, treatment and long-term management [CG54]

Measuring the use of this guidance

Recommendation: 1.1.1.1

Infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested after 24 hours at the latest

What was measured: Proportion of children under 3 years of age presenting with unexplained fever ≥38°C who had a urine sample tested within 24 hours.
Data collection end: December 2010
28%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.


Recommendation: 1.1.5.2

Refer all infants under 3 months with a suspected UTI (see table 1) to paediatric specialist care, and send a urine sample for urgent microscopy and culture manage in line with the NICE guideline on fever in under 5s.

What was measured: Proportion of children aged under 3 months with a suspected UTI who were referred to specialist paediatric care and had a positive urine culture result.
Data collection end: December 2010
89%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.


Recommendation: 1.1.5.4

The urine-testing strategy shown in table 2 is recommended for children aged 3 years or older. If both leukocyte esterase and nitrite are positive, the child should be regarded as having UTI and antibiotic treatment should be started. If a child has a high or intermediate risk of serious illness and/or past history of previous UTI, a urine sample should be sent for culture. If leukocyte esterase is negative and nitrite is positive, antibiotic treatment should be started if the urine test was carried out on a fresh sample of urine. A urine sample should be sent for culture. Subsequent management will depend upon the result of urine culture. If leukocyte esterase is positive and nitrite is negative, a urine sample should be sent for microscopy and culture. Antibiotic treatment for UTI should not be started unless there is good clinical evidence of UTI (for example, obvious urinary symptoms). Leukocyte esterase may be indicative of an infection outside the urinary tract which may need to be managed differently. If both leukocyte esterase and nitrite are negative, the child should not be regarded as having a UTI. Antibiotic treatment for UTI should not be started, and a urine sample not be sent for culture. Other causes of illness should be explored.

What was measured: Proportion of children aged 3 years and over who had a positive leucocyte or nitrite on dipstick testing and had a urine sample sent for microscopy and culture.
Data collection end: December 2010
77%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.

What was measured: Proportion of children aged 3 years and over who had a negative leucocyte and nitrite on dipstick testing and did not have a urine sample sent for microscopy and culture.
Data collection end: December 2010
67%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.


Recommendation: 1.1.7.1

The following risk factors for UTI and serious underlying pathology should be recorded: poor urine flow history suggesting previous UTI or confirmed previous UTI recurrent fever of uncertain origin antenatally diagnosed renal abnormality family history of vesicoureteric reflux (VUR) or renal disease constipation dysfunctional voiding enlarged bladder abdominal mass evidence of spinal lesion poor growth high blood pressure.

What was measured: Proportion of children with a confirmed UTI whose records indicate that all 12 risk factors were assessed.
Data collection end: December 2010
13%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.


Recommendation: 1.2.1.2

Infants younger than 3 months with a possible UTI should be referred immediately to the care of a paediatric specialist. Treatment should be with parenteral antibiotics in line with the NICE guideline on fever in under 5s.

What was measured: Proportion of children aged under 3 months who were seen by a paediatric specialist and treated with parenteral antibiotics.
Data collection end: December 2010
43%
Area covered: Multiple Local
Source: Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J, Gyoffry G,Pike K, Jadresic L. (2015) Implementation of NICE guidance on urinary tract infections in children in primary and secondary care. Acta Paediat. 2015; Vol 104(6):630-7.



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