Differences between the usual management of urinary tract infection in Primary Care and current recommendations

Objectives: to determine the incidence of urinary tract infection (UTI) in young children of Venta de Baños. To estimate the importance of the associated pathology to these infections. To evaluate the adequacy of the imaging to the proposals supplied by the NICE Guide about UTI in childhood.

Patients and methods: retrospective study reviewing the clinical records of the children born in Venta de Baños, between 2001 and 2006, taking information about urine cultures in their two first years of life, results, treatment and follow up. The imaging studies are compared with those proposed by the NICE Guide in august 2007.

Results: two hundred ninety-three clinical records were reviewed. The accumulated incidence of UTI has been 7.5%. Ecography was done in 90% of UTIs, VCUG (voiding cistoureterography) in 66% and DMSA (technetium-99m dimercaptosuccinic acid) in 18%. Ten percent of boys and 25% of girls had vesicouretal reflux (VUR), all of them in grade II. Following the NICE Guide recommendations, 75% of the VCUG were not indicated and the late DMSA was not done in 76% of the cases in which it would have been indicated.

Conclusions: our accumulated incidence of urinary infection is slightly higher than in other series. Our children had not complicated UTI and a low degree RVU. We have carried out fewer DMSA and more VCUG than the recommended in current guidelines. We have proposed for our health area a less aggressive follow up of urinary tract infection.

Keywords: Tests of image. Vesicoureteral reflux. Antibiotic prophylaxis. Urinary tract infection.