UTI in Children Aged 0-6 months: An Audit at West Middlesex University Hospital.

Abstract

Background:

In children under 6 months old, urinary tract infections (UTIs) can often be a sign of an underlying structural abnormality. As per NICE guidelines for children in this age group, all should receive an USS-KUB and only those with atypical UTIs or recurrent UTIs should receive a DMSA or MCUG. Currently at WMUH, a full work up with all three scans are performed for all children <6 months with a confirmed UTI regardless of organism. The aim of the audit was to review current practice at WMUH with the NICE guidelines for infants <6 months of age with E.coli UTIs.

Methods:

Data was collected retrospectively from all children aged under 6 months who were admitted to WMUH and treated for a UTI over a 2-cycle audit period from January 2017 to July 2020.  Data was collected on age, urine culture results, any imaging the child had received and if the result of the investigation was normal or abnormal.

Results:

A total of 82 children were aged under 6 months across both cycles. A total of 45 children (55%) had an E.coli positive UTI. 44 children underwent an US-KUB as per NICE guidelines of which 36% had an abnormal result (Figure 1). 32 children had an MCUG, of which 31% had abnormal results. 17 children had a DMSA scan of which 12% had abnormal results. Most interestingly, 32% of the children with normal US-KUB results went on to have abnormal MCUG results demonstrating vesico-ureteric reflux.

Conclusion:

Under recommended NICE guidelines, these infants with underlying structural abnormalities would not have been detected. Therefore, all children under 6 months of age with a UTI regardless of organism should have the full imaging work-up and trust guidelines should be updated.