title: Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery.
abstract: BACKGROUND
  The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown.
  
  
  OBJECTIVE
  To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery.
  
  
  METHODS
  Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales.
  
  
  METHODS
  Systematic urine sampling from children aged <5 years presenting in primary care with acute illness with culture in NHS laboratories.
  
  
  RESULTS
  Of 6079 children's urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, P<0.001). Of 231 children with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; P<0.001). Children with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005).
  
  
  CONCLUSIONS
  Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism's sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: Cochrane Institute of Primary Care and Public Health.
authors.forename: Kathryn
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pickles
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit;
authors.forename: Mandy
authors.initials: M
authors.lastname: Wootton
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit;
authors.forename: Robin
authors.initials: R
authors.lastname: Howe
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff.
authors.forename: Cherry-Ann
authors.initials: CA
authors.lastname: Waldron
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.affiliation: School of Social and Community Medicine;
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff.
authors.forename: Judith
authors.initials: J
authors.lastname: Van Der Voort
authors.affiliation: Bristol Royal Hospital for Children, Bristol.
authors.forename: Jan
authors.initials: J
authors.lastname: Dudley
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton.
authors.forename: Kate
authors.initials: K
authors.lastname: Rumsby
authors.affiliation: Centre for Academic Primary Care, University of Bristol, Bristol.
authors.forename: Harriet
authors.initials: H
authors.lastname: Downing
authors.affiliation: Centre for Academic Primary Care, University of Bristol, Bristol.
authors.forename: Kim
authors.initials: K
authors.lastname: Harman
authors.affiliation: Centre for Academic Primary Care, University of Bristol, Bristol.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D020380:Needs Assessment; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome; D016482:Urinalysis / Q000379:methods / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D014852:Wales / Q000453:epidemiology
chemical_list: D000892:Anti-Infective Agents, Urinary
keywords: antibacterial agents; child; diagnosis; primary health care; urinary tract infections
references.citation: Arch Dis Child. 2002 Dec;87(6):530-2
references.pmid: 12456556
references.citation: BMJ. 2003 Sep 20;327(7416):656
references.pmid: 14500439
references.citation: Arch Dis Child. 2009 May;94(5):337-40
references.pmid: 19066174
references.citation: Br J Gen Pract. 2009 Oct;59(567):e321-8
references.pmid: 19843412
references.citation: Scand J Prim Health Care. 2011 Mar;29(1):19-22
references.pmid: 21323495
references.citation: BMC Infect Dis. 2012 Jul 19;12:158
references.pmid: 22812651
references.citation: Br J Gen Pract. 2013 Feb;63(607):e156-64
references.pmid: 23561695
references.citation: Arch Dis Child. 2014 Apr;99(4):342-7
references.pmid: 24351607
references.citation: Health Technol Assess. 2016 Jul;20(51):1-294
references.pmid: 27401902
references.citation: Fam Pract. 1997 Feb;14(1):44-8
references.pmid: 9061344