RESUMO
Urinary tract infection (UTI), is one of the commonest bacterial diseases in childhood, and may cause significant morbidity, inconvenience and anxiety for patients and their families and result in considerable consumption of resources. Although most clinicians would agree on the general principles of management, it is recognised that considerable variation exists in their application. The aim of this study was to assess the in-patient and out-patient management practice in infants and children with documented symptomatic UTI in several clinical areas in the Royal Hospital for Sick Children (RHSC) Glasgow. A total of 1,826 patient episodes were analysed, 1,592 of which were first referrals over a 29 month study period. The analysis highlighted a definite variation in a number of aspects of the management of UTI within the clinical services reviewed. In a significant number of in-patients, the diagnosis was made both in the absence of microbiological confirmation, and following the use of inappropriate urine specimens. An under-use of urine microscopy in the in-patient services was documented as well as an inappropriate use in out-patients, since the result in this latter group did not seem to influence the need for urine culture. Urinary tract imaging protocols varied widely between in-patient services and among in-patient and out-patient services with a continued over-reliance on urinary tract ultrasound and an under-use of more sensitive radio-isotopic techniques. These data reveal a continuing lack of uniformity in management practices in children with UTI and demonstrate the need for a wider application of practice guidelines.
