Urinary tract infection
Urinary tract infection (UTI) is one of the commonest disorders of childhood, affecting an estimated 82 000 children a year in the UK. The investigation and management of children with UTI generates a substantial workload for paediatric urologists and paediatric nephrologists as well as for general paediatricians. The presentation of UTI in this age group is varied and the diagnosis can sometimes be problematic, particularly in young infants in whom the clinical picture is often non-specific and reliable urine samples are difficult to obtain. Despite these diagnostic difficulties, the greater awareness of the importance and prevalence of UTI in children coupled with the availability of sensitive dipstick reagent strips has resulted in the detection of UTI on a far greater scale than in the past. As a consequence of better diagnosis of UTI by general practitioners, many more children with mild or asymptomatic lower tract urinary infections are now being referred for investigation. To a large extent, however, recent protocols for the investigation and management of childhood UTI date from a time when children referred for investigation tended to be those with more severe infection. The use of outdated protocols has had the result that many children with lower tract UTIs have been
subjected to unnecessary (and often needlessly invasive) investigations. Moreover, the burden of unnecessary investigations has significant financial implications for the National Health Service. To address these concerns the UK’s National Institute for Health and Clinical Excellence (NICE) has recently produced new guidelines based on an extensive analysis of the published evidence. These guidelines are intended to encompass referral practice, a more selective approach to diagnostic imaging and evidence-based recommendations on management. The NICE guidelines have been criticised by some clinicians on the grounds that they might lead to under investigation of some children with clinically significant UTIs, scarring and reflux. Where appropriate, reference will be made to the 2007 NICE guidelines in this chapter.