학술논문
Low yield from imaging after non -E. coli urine tract infections in children treated in primary care and emergency department.
Document Type
Academic Journal
Author
Tse Y; Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK yincenttse@nhs.net.; Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK.; Pickles C; Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK.; Owens S; Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.; Malina M; Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK.; Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.; Peace R; Department of Nuclear Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.; Gopal M; Department of Paediatric Urology, Great North Children's Hospital, Newcastle upon Tyne, UK.
Source
Publisher: BMJ Pub. Group [etc.] Country of Publication: England NLM ID: 0372434 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2044 (Electronic) Linking ISSN: 00039888 NLM ISO Abbreviation: Arch Dis Child Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Imaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non -E. coli is considered high risk in many national guidelines, but evidence is mainly drawn from small cohorts from tertiary centres.
Objective: To ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >100 000 cfu per ml) in primary care or an emergency department without admission stratified by bacteria type.
Design, Setting, Patients: Data were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months.
Results: 7730 children (79% girls, 16% aged <1 year, 55% 1-4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%). E. coli UTI yielded abnormal kidney imaging in 8.9% (566/6384). Enterococcus and KPP ( Klebsiella , Proteus , Pseudomonas ) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality.
Conclusion: In this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non -E. coli UTI was not associated with a higher yield from renal tract imaging.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Objective: To ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >100 000 cfu per ml) in primary care or an emergency department without admission stratified by bacteria type.
Design, Setting, Patients: Data were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months.
Results: 7730 children (79% girls, 16% aged <1 year, 55% 1-4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%). E. coli UTI yielded abnormal kidney imaging in 8.9% (566/6384). Enterococcus and KPP ( Klebsiella , Proteus , Pseudomonas ) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality.
Conclusion: In this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non -E. coli UTI was not associated with a higher yield from renal tract imaging.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)