Incidence rates and trends of childhood urinary tract infections and antibiotic prescribing: registry-based study in general practices (2000 to 2020)

Abstract

Background To improve the management of childhood urinary tract infections, it is essential to understand the incidence rates, testing and treatment strategy. Methods A retrospective study using data from 45 to 104 general practices (2000 to 2020) in Flanders (Belgium). We calculated the incidence rates (per 1000 person-years) of cystitis, pyelonephritis, and lab-based urine tests per age (< 2, 2-4, 5-9 and 10-18 years)) and gender in children and performed an autoregressive time-series analysis and seasonality analysis. In children with UTI, we calculated the number of lab-based urine tests and antibiotic prescriptions per person-year and performed an autoregressive time-series analysis. Results There was a statistically significant increase in the number of UTI episodes from 2000 to 2020 in each age group (p < 0.05), except in boys 2-4 years. Overall, the change in incidence rate was low. In 2020, the incidence rates of cystitis were highest in girls 2-4 years old (40.3 /1000 person-years 95%CI 34.5-46.7) and lowest in boys 10-18 (2.6 /1000 person-years 95%CI 1.8-3.6) The incidence rates of pyelonephritis were highest in girls 2-4 years (5.5, 95%CI 3.5-8.1 /1000 person-years) and children < 2 years of age (boys: 5.4, 95%CI 3.1-8.8 and girls: 4.9, 95%CI 2.7-8.8 /1000 person-years). In children 2-10 years, there was an increase in number of lab-based urine tests per cystitis episode per year and a decrease in total number of electronic antibiotic prescriptions per cystitis episode per year, from 2000 to 2020. In children with cystitis < 10 years in 2020, 51% (95%CI 47-56%) received an electronic antibiotic prescription, of which the majority were broad-spectrum agents. Conclusions Over the last 21 years, there was a slight increase in the number of UTI episodes diagnosed in children in Flemish general practices, although the overall change was low. More targeted antibiotic therapy for cystitis in accordance with clinical guidelines is necessary to reduce the use of broad-spectrum agents in children below 10 years.

The Prevalence of Bacterial Urinary Tract Infections Among School-age Children

“…The results show that Escherichia coli (E. coli) was the predominant bacterial agent in causing urinary tract infections (UTIs) among school-age children, accounting for 74% of cases. This finding is consistent with previous studies, as E. coli is a common pathogen responsible for the majority of UTIs, especially in community settings [2,8,9,23,29]. Enterococcus faecalis, Enterobacter aerogenes, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa were found to be responsible for UTIs, albeit at lower rates.…”

“…In toilet-trained children, typical urinary symptoms like frequent urination, suprapubic or abdominal pain, loin tenderness, changes in incontinence habits, and dysuria are evident. [2,[8][9][10][11]. The infection can affect either the upper urinary tract (pyelonephritis) or the lower urinary tract (cystitis).…”

“…In 2020, girls aged 2-4 had the highest cystitis rates (40.3/1000 person-years) and boys aged 10-18 had the lowest rates (2.6/1000 personyears). Girls aged 2-4 also had the highest pyelonephritis rates, especially those under 2 years old [8]. Early detection and treatment of UTIs in children is crucial to avoid complications like kidney damage or repeated infections.…”

Cystitis in Children

“…From the second year onwards, the incidence of cystitis and UTI, in general, are more common in girls [2]. School-aged girls have a UTI incidence of 1-3%, and with the start of sexual activity, it rises up to 10% [3,7,8]. Asymptomatic bacteriuria is more common in school-aged girls [3%] and male newborns (1%) [5].…”

Increased Levels of (p)ppGpp Correlate with Virulence and Biofilm Formation, but Not with Growth, in Strains of Uropathogenic Escherichia coli

“…Urinary tract infections (UTIs) are among the most frequently occurring major bacterial infections worldwide, and their significant increase in incidence in recent years is alarming [ 1 , 2 , 3 ]. It is estimated that 150 million UTIs occur annually worldwide, with significant morbidity and high treatment costs affecting the efficiency of national health care systems [ 4 ].…”