UTI Referrals

Dr Rick Fulton09/06/2014

UTI

• NICE guidelines

• Definitions

• When to refer

NICE Guidelines

• Upper vs lower UTI – Fever >38 C = upper (7-10d antibiotics)

• <3y old if microscopy does not show WC in urine but culture is positive = treat as UTI

• <3m old with UTI – refer ALL acutely

DefinitionsAtypical UTI Recurrent UTI

Seriously ill Two or more episodes of UTI with acute pyelonephritis/ upper urinary tract infection

Failure to respond to treatment with suitableantibiotics within 48 hours

One episode of UTI with acute pyelonephritis/upper urinary tract infection plus one or more episode of UTI with cystitis/lower urinary tract infection

Abdominal or bladder mass Three or more episodes of UTI with cystitis/lower urinary tract infection

Raised creatinine

Septicaemia

Poor urine flow

Infection with non-E. coli organisms

NICE Guidance

• Imaging – Consider if recurrent or atypical UTI (recurrent = 2 or more)

• <6m – if atypical or recurrent – USS, DMSA, MCUG (if typical = USS only)

• 6m-3y – if atypical or recurrent – USS, DMSA

• >3y – if atypical or recurrent – USS (consider DMSA)

Referrals

• Refer if atypical or recurrent in <6m

• Suggest referral if atypical or recurrent 6m-3y

• Consider referral if USS abnormal in >3y

References

• Urinary Tract Infection in Children. NICE Guidelines. CG 54. 2007.

• Hascombe guidelines.