1887

Abstract

The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all ‘infants and children with atypical UTI (including non- infections) should have renal imaging after a first infection’. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. that were not were reported only as coliforms (rather than non- coliforms) by 61 % (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54 % for general practice (GP) paediatric urines; 61 % of laboratories (confidence interval 52–70 %) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 10 c.f.u. l. Only 22 % (24/110) of laboratories reported non- coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a quarter of laboratories were providing a service that would allow clinicians to fully comply with the first line recommendations in the 2007 NICE UTI in children guidance. Laboratory urine submission report figures suggest that the guidance has not led to an increase in diagnosis of UTI in children under 3 years old.

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2015-09-01
2019-10-20
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References

  1. Aspevall O. , Osterman B. , Dittmer R. , Stén L. , Lindbäck E. , Forsum U. . ( 2002;). Performance of four chromogenic urine culture media after one or two days of incubation compared with reference media. J Clin Microbiol 40: 1500–1503 [CrossRef] [PubMed].
    [Google Scholar]
  2. Coulthard M. G. , Kalra M. , Lambert H. J. , Nelson A. , Smith T. , Perry J. D. . ( 2010;). Redefining urinary tract infections by bacterial colony counts. Pediatrics 125: 335–341 [CrossRef] [PubMed].
    [Google Scholar]
  3. Downing H. , Thomas-Jones E. , Gal M. , Waldron C.-A. , Sterne J. , Hollingworth W. , Hood K. , Delaney B. , Little P. , other authors . ( 2012;). The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infectious Diseases 12: 158.[CrossRef]
    [Google Scholar]
  4. Hansson S. , Brandström P. , Jodal U. , Larsson P. . ( 1998;). Low bacterial counts in infants with urinary tract infection. J Pediatr 132: 180–182 [CrossRef] [PubMed].
    [Google Scholar]
  5. Hay A. D. , Hood K. , Sterne J. , Dudley J. , van der Voort J. , Howe R. , Wooton M. , MacGowan A. , Delaney B. , other authors . ( 2013;). The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study: the development of a clinical algorithm to improve the recognition of urinary tract infection (UTI) in pre-school children presenting to primary care. Arch Dis Child 98: (Suppl. 1), A45 [CrossRef].
    [Google Scholar]
  6. Healthcare Quality Improvement Partnership (HQIP) ( 2013;). Primary & Secondary Care multi-site audit of NICE guidance on Urinary Tract (UTI) (HQIP NCA 075). http://www.hqip.org.uk/current-multi-site-audits/ Accessed 27 February 2014.
  7. Jantunen M. E. , Siitonen A. , Ala-Houhala M. , Ashorn P. , Föhr A. , Koskimies O. , Wikström S. , Saxén H. . ( 2001;). Predictive factors associated with significant urinary tract abnormalities in infants with pyelonephritis. Pediatr Infect Dis J 20: 597–601 [CrossRef] [PubMed].
    [Google Scholar]
  8. Kanellopoulos T. A. , Vassilakos P. J. , Kantzis M. , Ellina A. , Kolonitsiou F. , Papanastasiou D. A. . ( 2005;). Low bacterial count urinary tract infections in infants and young children. Eur J Pediatr 164: 355–361 [CrossRef] [PubMed].
    [Google Scholar]
  9. Kass E. H. . ( 1962;). Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med 56: 46–53 [CrossRef] [PubMed].
    [Google Scholar]
  10. Kouri T. , Flogazzi G. , Gant V. , Hallender H. , Hofmann W. , Guder W. . ( 2000;). G. European Urinalysis Guidelines. Scand J Clin Lab Invest 60: 1–96 .[CrossRef]
    [Google Scholar]
  11. McNulty C. A. , Bowen J. , Clark G. , Charlett A. , Cartwright K. , South West G Microbiology Laboratory Use Group . ( 2004;). How should general practitioners investigate suspected urinary tract infection? Variations in laboratory-confirmed bacteriuria in South West England. Commun Dis Public Health 7: 220–226 .
    [Google Scholar]
  12. McNulty C. A. M. , Thomas M. , Bowen J. , Buckley C. , Charlett A. , Gelb D. , Foy C. , Sloss J. , Smellie S. . ( 2008;). Improving the appropriateness of laboratory submissions for urinalysis from general practice. Fam Pract 25: 272–278 [CrossRef] [PubMed].
    [Google Scholar]
  13. National Institute for Clinical Excellence ( 2007;). National Collaborating Centre for Women's and children's Health. Urinary tract infection in children. Clinical guideline 54. http://www.nice.org.uk/guidance/cg54. Accessed 9 October 2014.
  14. National Institute for Clinical Excellence ( 2013;). Urinary tract infection in infants, children and young people under 16.NICE quality standard 36. http://www.nice.org.uk/guidance/qs36. Accessed 9 October 2014.
  15. Orellana P. , Baquedano P. , Rangarajan V. , Zhao J. H. , Eng N. D. C. , Fettich J. , Chaiwatanarat T. , Sonmezoglu K. , Kumar D. , other authors . ( 2004;). Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Pediatr Nephrol 19: 1122–1126 [CrossRef] [PubMed].
    [Google Scholar]
  16. Statacorp. ( 2011;). Stata Statistical Software: Release 12 College Station, TX: StataCorp LP.
    [Google Scholar]
  17. The Standards Unit, Public Health England UK ( 2014;). UK Standards for Microbiology Investigations Investigation of Urine BSOP 41, Issue no 7.2, Issue date: 18.07.14. https://www.gov.uk/government/publications/smi-b-41-investigation-of-urine. Accessed 6 October 2014.
    [Google Scholar]
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