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The Article in Brief
Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study
Alastair D. Hay , and colleagues
Background Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. In addition, although urine culture is essential for diagnosis, urine collection is often difficult. This study aims to develop a two-step clinical rule using symptoms and signs to select children for urine collection; and symptoms, signs and dipstick testing to guide antibiotic treatment.
What This Study Found Among young children, having a previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination are associated with UTI. These factors can be used for selecting children for whom a urine sample (step 1) and dipstick results would improve specificity for antibiotic treatment (step 2). Clinician preference should determine how these findings are used; some may use the risk factors to supplement clinical judgement while others may use a checklist approach and the points-based clinical rule.
Implications
- The authors call for further research to distinguish pathogens from contamination and asymptomatic bacteriuria.