Urinary tract infection

Introduction

Urinary tract infections (UTI’s) are common in children. ^1,2

Urine samples must be a clean catch or catheter specimen, bag urines are not acceptable. ^1,2

The last decade has seen a significant change in the approach to the investigation and management of children following a first UTI. Both the National Institute for Health and Care Excellence and the American Academy of Paediatrics published guidelines that support a far less aggressive approach to the imaging of children with UTI's (i.e., infrequent use of micturating cystourethrogram and DMSA) and the cessation of routinely commencing prophylactic antibiotics and proof of cure urine samples. ^{1,2, 3}

Pre-referral investigations

Renal tract ultrasound for:

• All children < 6months old with a confirmed UTI
• All children with an atypical UTI¹:
  • poor urine flow
  • abdominal or bladder mass
  • renal impairment
  • non E.coli organism
  • failure to respond to appropriate treatment
• Children with recurrent UTI’s¹:
  • ≥ 2 episodes of pyelonephritis
  • 1 episode of pyelonephritis plus ≥ 1 episode of cystitis
  • ≥ 3 episodes of cystitis

If the ultrasound is normal no further investigation is necessary. ^{1, 2, 3}

For current guidelines on assessment and management, visit Clinician Assist WA » Urinary Tract Infection (UTI) in Children

When to refer

• Children with an atypical (e.g. non E.coli) UTI^1,3
• Children with recurrent UTI’s^1,3
• Children with an abnormal renal tract ultrasound^1,3

 How to refer

• Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
• Routine non-urgent referrals from private hospitals are made via the PCH Referral Office (Fax: 6456 0097 or email PCH.Referrals@health.wa.gov.au)
• Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the General Paediatrics doctor on-call.

Essential information to include in your referral

• Urine MC+S results
• Renal ultrasound result if available

References

1. National Institute for Health and Care Excellence (NICE). Urinary tract infection in under 16s: diagnosis and management. National Institute for Health and Care Excellence: Guidelines [NG224]. London 2022. Available from: http://www.nice.org.uk/guidance/ng224
2. Larkins N, Hewitt I. Urinary Tract Infection in Children. Current Pediatrics Reports. 2018;6:259-268
3. http://www.rch.org.au/clinicalguide/guideline_index/Urinary_tract_infection_guideline

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