Low yield from imaging after non-E. coliurine tract infections in children treated in primary care and emergency department

Abstract

BackgroundImaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coliis considered high risk in many national guidelines, but evidence is mainly drawn from small cohorts from tertiary centres.ObjectiveTo ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >1 00 000 cfu) in primary care or an emergency department without admission stratified by bacteria type.Design, setting, patientsData were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months.Results7730 children (79% girls, 16% aged <1 year, 55% 1–4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%).E. coliUTI yielded abnormal kidney imaging in 8.9% (566/6384).Enterococcusand KPP (Klebsiella,Proteus,Pseudomonas) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality.ConclusionIn this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non-E. coliUTI was not associated with a higher yield from renal tract imaging.