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Low yield from imaging after non-E. coli urine tract infections in children treated in primary care and emergency department

Lookup NU author(s): Dr Yincent TseORCiD, Dr Stephen Owens, Dr Michal Malina, Dr Richard Peace, Milan Gopal

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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 >100 000 cfu per ml) 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.Keywords: Emergency Care; Infectious Disease Medicine; Microbiology; Nephrology; Primary Health Care.

Publication metadata

Author(s): Tse Y, Pickles C, Owens S, Malina M, Peace R, Gopal M

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood

Year: 2023

Volume: 108

Issue: 6

Pages: 474-480

Print publication date: 18/05/2023

Online publication date: 03/03/2023

Acceptance date: 17/02/2023

ISSN (print): 0003-9888

ISSN (electronic): 1468-2044

Publisher: BMJ Publishing Group

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

DOI: 10.1136/archdischild-2022-324930

PubMed id: 36868793

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