6061 Analysis of renal tract imaging requested for children under 16 years with culture positive urinary tract infection (UTI) – adherence to NICE guidelines

Objectives UTI is commonly encountered in children and can be the first manifestation of congenital anomalies of the kidneys and urinary tract (CAKUT).¹ There are controversies surrounding diagnosis, imaging and management but imaging remains the central area of debate.² The NICE guidelines for managing UTIs in under 16 years were published in August 2007 and updated in September 2017 and 2022.³ The objectives of the study were to analyse our current practice of ordering imaging in culture- positive UTIs in children under 16 years and to assess compliance with NICE guidelines (2017). Methods A retrospective study was conducted at our trust on children under 16 years diagnosed with culture-positive UTI between January 2017 and January 2019. The first 75 children on the list were included;10 children with antenatal diagnosis of renal tract abnormalities or with urine culture showing mixed growth or bacterial growth less than 10⁴ CFU were excluded. Data was collected from medical records. The imaging modality ordered was analysed against NICE recommendations. As per NICE guidelines, children were divided into three categories based on age and the imaging pathway was evaluated based on first, recurrent and/or atypical UTI. Results Out of the cohort of 65 patients, 48(73%) were male and 17(27%) were females. The age distribution of children showed that 5(8%) were under 6 months,25(38%) were 6 months-3 years and 35(54%) were over 3 years.Out of the total cohort 33 (51%) children had their first UTI,20 (31%) had recurrent UTI and 12 (18%) had atypical UTI. E. coli was the most common organism in urine culture in 57(87%) patients. Two patients had Proteus, 2 had Klebsiella and 1 each grew Pseudomonas, Enterococcus faecalis, Staphylococcus aureus and Citrobacter freundii in urine culture. The overall compliance of investigations was compared against NICE recommendations as shown in figure 1. Among 65 children, 41 had renal tract ultrasound of which, 27(66%) were requested as per guidelines and 14(34%) were not. DMSA was requested in 14 children:13(93%) were compliant and 1(7%) was non-compliant. MCUG was requested in 7 children: 4(57%) were compliant and 3(43%) were not. Conclusion E. coli was the most common organism grown in urine culture. Overall, compliance with NICE guidelines for DMSA requests was good but was poor when requesting USS/MCUG. Reiteration to staff to follow NICE guidelines and acknowledge the update in 2022 would help request imaging appropriately and avoid unnecessary investigations. References ML Palacios Loro, Ramirez D, Álvarez F, Fernando Santos Rodríguez. Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician. Anales de Pediatría (English Edition) [Internet]. 2015 Dec 1 [cited 2023 Oct 16];83(6):442.e1–5. Available from: https://www.analesdepediatria.org/en-congenital-anomalies-kidney-urinary-tract--articulo-S2341287915002811 Kari JA, Kjell Tullus.Controversy in Urinary Tract Infection Management in Children: A Review of New Data and Subsequent Changes in Guidelines. Journal of Tropical Pediatrics [Internet]. 2013 Jun 28 [cited 2023 Oct 16];59(6):465–9. Available from: https://pubmed.ncbi.nlm.nih.gov/23812014. Recommendations:Urinary tract infection in under 16s:diagnosis and management | Guidance | NICE [Internet]. Nice.org.uk. NICE; 2022 [cited 2023 Oct 16]. Available from: https://www.nice.org.uk/guidance/ng224/chapter/Recommendations.