Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study.
BACKGROUND
We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections.


METHODS
During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral.


RESULTS
The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred.


CONCLUSIONS
This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.
Kwok
Wing-Yee
WY
Department of General Practice, Erasmus MC - University Medical Center Rotterdam, PO Box 1738, 3000 DR, Rotterdam The Netherlands. wykwok55@hotmail.com
de Kwaadsteniet
Marjolein C E
MC
Harmsen
Mirjam
M
van Suijlekom-Smit
Lisette W A
LW
Schellevis
François G
FG
van der Wouden
Johannes C
JC
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D004363:Drug Utilization / Q000592:standards; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population; D012621:Seasons; D014505:Urban Population; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology*
D000890:Anti-Infective Agents