Management of suspected urinary tract infection: what is the clinical practice in our setting?

Introduction: urinary tract infection (UTI) is one of the most common bacterial infections in paediatrics. Its diagnosis involves the prescription of antibiotics and may require imaging studies. The aim of this study is to understand healthcare practices when UTI is suspected (SUTI) and identify areas for improvement.

Patients and methods: this was an prospective, observational, descriptive, longitudinal, multicentre, national study conducted in primary care paediatric (October 2019-December 2020). The study population included children aged 0 to 15 years with SUTI.

Results: were obtained 1402 records. In 763 cases, UTI was considered confirmed (CUTI). In most cases, suspicion was based on associated symptoms. Urine culture was performed in 74.5% of SUTI (86.4% of CUTI) and in 19% only urine dipstick testing. In 24.1% of CUTI episodes in incontinent patients, urine culture was performed using only a urine bag. Empirical antibiotic treatment was initiated in 66.7%. The most commonly prescribed antibiotics were third-generation cephalosporins, fosfomycin trometamol, cefuroxime, and amoxicillin-clavulanate. The average total duration was 8.5 and 6.9 (febrile and afebrile processes) days. Hospital admission was required in 9.3%, ultrasound was requested in 17.8%, and referral to nephrology was required in 8%. Outcome was considered favourable in 83.6%, (94% in CUTI), although follow-up urine culture was requested in 18.2%, (29.4% in CUTI). Prophylaxis was initiated in 2%.

Conclusions: when UTI is suspected, it is necessary to improve the diagnostic process by collecting urine cultures using the appropriate technique, adjusting the duration of treatment and the drugs prescribed, and reducing follow-up urine cultures.