Management of culture positive urinary tract infections in children aged 0-16 years: An audit conducted in a District General Hospital in the United Kingdom

Background: Urinary tract infection (UTI) is common among children. Management of UTI requires prompt diagnosis, treatment and most often, a regular follow up.

Objectives: To evaluate compliance with the NICE guidelines 2007 when managing children aged 0 to16 years with bacteriologically proven UTI in a District General Hospital.

Method: A descriptive retrospective study was carried out at Bronglais General Hospital, Aberystwyth, United Kingdom (UK) on children aged 0 to16 years with culture positive UTI from 1^st January 2012 to 31^st December 2014. Infants and children with urinary catheters in situ, pre-existing renal disorders and immune-suppression were excluded from the study. Patients were grouped into age categories to facilitate comparison of treatment and radiological investigations. Further categorisation was done according to NICE guidelines for urinary tract infection in children. Approval for the conduct of the audit was given by the Clinical Audit Department, Bronglais Hospital, UK. Ethical clearance for the study was obtained from the Ethical Review Committee of the Sri Lanka College of Paediatricians.

Results: There were 104 children aged 0 to 16 years with culture proven UTI during the study period of whom 8 were excluded. Only 25% of infants 3 months old or less received intravenous (IV) antibiotics in compliance with the guidelines; 25% had only oral antibiotics and 50% had IV followed by oral antibiotics. For treatment of lower tract infection, duration of antibiotics prescription was longer than recommended. Overall adherence to investigations such as ultrasonography, dimercaptosuccinic acid scan and micturating cystourethrogram was 81%, 91% and 93% respectively. All children with recurrent UTIs were prescribed antibiotic prophylaxis adhering to NICE guidelines.

Conclusions: Duration of antibiotic therapy in UTI was in compliance with NICE guidelines in 16-86% children. Radiological investigations were requested in UTI in compliance with NICE guidelines in 71-97% children. Prophylactic antibiotics were prescribed in UTI in compliance with NICE guidelines in 34-100% children.