How to diagnose urinary tract infections (UTI) in the under fives

How to diagnose urinary tract infections (UTI) in the under fives is the focus of the latest issue of EFFECTIVE HEALTH CARE.
UTI is common in children. Around 6.3% of girls and 2.4% of boys will be referred with UTIs by the age of five years. Children who are misdiagnosed can either fail to receive appropriate treatment or receive unnecessary treatment and investigation.

Good management involves prompt diagnosis, rapid treatment and the detection of any underlying cause that might lead to further infections or long-term renal damage.

A systematic review of the research evidence has shown that:

• Urine dipstick tests can be used to guide initial diagnosis. For UTIs in children the most useful dipstick tests are leucocyte esterase (LE) and nitrite. The evidence showed that if these two particular tests were positive, (nitrite and leukocyte esterase (LE)) then there was a very high likelihood of a UTI.
• Further investigations for UTI can be unpleasant and carry risks as they generally involve catheterization and/or radiation (distressing for children and parents/guardians). It has been shown that if the urine dipstick tests for both LE and nitrite are negative, or microscopic analysis is negative for an infection, the need for further investigation for UTI can be avoided.
• Only children with a recurrent UTI should be considered for further investigation.
• There is no evidence to support ‘routine’ imaging of children with UTI; requests for imaging should be made by clinicians on an individual child basis in full consultation with the parents/guardians.

Further information about this issue of Effective Health Care can be obtained from Alison Booth or Paul Wilson, Tel: 01904 321040, Fax 01904 321041.