Unexplained extra visits to general practitioners before the diagnosis of first urinary tract infection: a case-control study

Abstract

Aims: To determine: (1) whether children diagnosed with a urinary tract infection (UTI) visited their general practitioner (GP) more frequently before the diagnosis of UTI was established compared to children never diagnosed with a UTI; and (2) whether those children with evidence of renal scarring at their first diagnosed UTI visited their GPs more frequently before diagnosis compared to children who did not have evidence of renal scarring when their first UTI was investigated. Methods: Case-control study of 77 children with a UTI identified from a hospital radiology database (37 with and 40 without renal scarring), and 77 age, sex, and general practice matched controls. Main outcome measures were entries in general practice clinical records for types of illness, antibiotic prescriptions, and urine samples requested prior to the diagnosis of first UTI (cases) or equivalent time periods for controls. Results: Cases had a mean 2.94 additional visits or 21% more visits (95% CI 1% to 41%) in the period (mean 2.4 years) prior to the visit at which their first UTI was diagnosed, including a mean 2.5 additional visits or 23% more visits for infectious illness (95% CI 1% to 45%). The cases had 114% (95% CI 41% to 184%) more visits for symptoms relating to the genitourinary tract, though the actual number of these visits was small. They were febrile at 49% more visits (95% CI 1% to 99%) and received significantly more courses of antibiotics than controls (5.2 v 4.1). They had more urine samples requested (37 v 3). Both the cases with and without renal scarring had similar excess GP visits. Conclusion: Compared to controls, children diagnosed with a first UTI had more visits at which symptoms of infection were recorded and more antibiotics prescribed prior to the visit at which the first UTI was diagnosed. These excess visits may have included undiagnosed UTIs. Both those with and without renal scarring had a similar degree of excess visits; additional aetiological factors must have played a role in scar formation. U rinary tract infections (UTIs) are most common in the first years of life, but reported incidences vary by country and setting. Studies in general practice in the UK found the incidence in children under 2 years of age ranged from 0% to 4%.

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

“…5 When the threshold for prescribing antibiotics for children with non-specific symptoms is low, children with 'occult UTI' may be serendipitously treated for their UTI. 6 A small UK study found that children with UTI that had not been suspected by the GP had all received antibiotics (amoxicillin) for alternative infections. 7 In the 1990s, antibiotic prescriptions for children reduced by almost one-third in the UK, US, and many European countries.…”

Mild pyelectasis diagnosed by prenatal ultrasound is not a predictor of urinary tract morbidity in childhood

“…Another reason for the high prevalence of UTI-at least in the case group-might be that general practitioners in this area are more focussed on a UTI because of the advice given to the parents to have the urine checked if their child is lethargic or develops a fever of unknown origin. Earlier studies have reported that UTIs are underdiagnosed in children and concluded that a greater awareness of the importance of investigation and management of UTI in children is needed because infections may lead to renal scarring (Jadresic et al, 1993;van der Voort et al, 1997;Van Der Voort et al, 2002). Shaw et al (1998) reported that even the presence of another potential source of fever, such as otitis media or respiratory infection, does not reliably exclude UTI.…”

Pathogenesis and prognosis of intrarenal reflux

“…Based on DMSA findings, a reflux nephropathy score (RNS) has been proposed using a 5-point scale from 0-4 [1,2]:…”

“…Most cases of vesicoureteral reflux (VUR) are detected pre-symptomatically either by investigating remaining congenital hydronephrosis or in the context of a preventive examination [1,2]. Scar development as a consequence of VUR can be detected from the intrauterine period of life (fetal reflux nephropathy -FRN) [3].…”