Management of urinary tract infection in a tertiary children's hospital before and after publication of the NICE guidelines

Judkins, Agnieshka, Pascoe, Elaine and Payne, Donald (2013) Management of urinary tract infection in a tertiary children's hospital before and after publication of the NICE guidelines. Archives of Disease in Childhood, 98 7: 521-525. doi:10.1136/archdischild-2012-303032

Author Judkins, Agnieshka
Pascoe, Elaine
Payne, Donald
Title Management of urinary tract infection in a tertiary children's hospital before and after publication of the NICE guidelines
Journal name Archives of Disease in Childhood   Check publisher's open access policy
ISSN 0003-9888
Publication date 2013-05-16
Sub-type Article (original research)
DOI 10.1136/archdischild-2012-303032
Open Access Status Not yet assessed
Volume 98
Issue 7
Start page 521
End page 525
Total pages 5
Place of publication London, United Kingdom
Publisher B M J Group
Formatted abstract
Introduction The UK National Institute for Health and Clinical Excellence (NICE) introduced guidelines for the diagnosis, treatment and management of urinary tract infection (UTI) in children and adolescents in August 2007.

Aim The primary aim was to determine whether publication of NICE guidelines was associated with a change in the use of diagnostic imaging investigations in patients with a documented first UTI in a tertiary children's hospital. Secondary aims were to describe the epidemiology, microbiology, prescription of prophylactic antibiotics and follow-up for these children, and the incidence of structural renal tract abnormalities, vesicoureteric reflux and renal uptake defects identified.

Methods Retrospective review of the case notes of patients presenting to Princess Margaret Hospital, Perth, Western Australia with a first UTI over a 4-year period (August 2005–2009). Details of demographics, radiological investigations, microbiology and follow-up were obtained. Data for subjects presenting before and after 31 August 2007 were compared.

Results Data from 659 subjects, median age 6 (range 0–186) months were analysed. Compared with the pre-NICE period, there was no change in the proportion of patients undergoing renal USS in the 2 years following publication of the guidelines. There was a decrease in the proportion undergoing MCUG (p<0.0001) and receiving antibiotic prophylaxis (p<0.0001) and an increase in the proportion undergoing DMSA (p<0.001).

Conclusions Practice changed following publication of the NICE guidelines. While the reduction in MCUG requests and prescription of antibiotic prophylaxis is in line with NICE guidelines, the increase in DMSA requests is contrary to the recommendations.

What is already known on this topic
▸ Routine radiological investigation and prophylactic antibiotic use following first-time urinary tract infection in children has been the mainstay of clinical practice for many decades.
▸ Over the last few years, the scientific literature has advocated a less invasive and aggressive approach.

What this study adds
▸ Paediatricians in western Australia are responding to the scientific literature and being more discerning in the use of invasive investigations and prophylactic antibiotics.
▸ Demographic and microbiological characteristics of urinary tract infection in our hospital are similar to those described in other Australian centres.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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Created: Mon, 09 Jun 2014, 20:46:52 EST by Elaine Pascoe on behalf of Medicine - Princess Alexandra Hospital