Key points are not available for this paper at this time.
Objectives Fever is one of the most common paediatric presentations to healthcare, and babies aged under 3 months have the highest risk of serious bacterial infection (SBI).1 NICE guidelines state all infants under 3 months with fever should have inflammatory markers (full blood count and CRP), blood culture, and urine culture.2 We routinely take these blood tests during cannulation, as this demographic of children are likely to receive IV antibiotics. However, due to difficulty obtaining clean catch urine samples, we are less likely to obtain a urine culture. The alternative option of catheter sample or suprapubic aspiration required equipment and expertise, and may cause distress to child and parents.3 This poses an issue, as urinary tract infections (UTI) are the most common cause of SBI in this age range,1 and cultures are likely to be less sensitive post parenteral antibiotic initiation.4 Furthermore, infants 5 Methods We retrospectively audited all febrile infants Results 24 of 30 eligible babies had a urine dip performed (80%). 8 were positive for leucocytes, nitrites or blood, and of these, 4 were also culture positive. This means 50% of positive urine dips were associated with a confirmed UTI. Of the 16 negative dips, only 1 was culture positive (6%). 21 of 30 babies had urine sent for culture. 11 of these were before antibiotics, 6 were post a dose of antibiotics, and 4 were not given antibiotics based on clinical signs. Of the babies who had urine samples sent before a dose of antibiotics, 45% were positive and 55% were negative. Of those who had urine samples sent post antibiotics, all cultures were negative. Conclusion This audit supports the established evidence that UTIs cause a significant proportion of febrile illnesses in infants. We meet NICE guideline of culturing urine before giving antibiotics in 37% of cases. This is an area for improvement in our practice, and the next steps are to present these findings locally and discuss how we can improve our performance with the paediatric medical and nursing teams. References Febrile illness- Emergency management in children, Queensland Emergency Care Children Working Group, 2023. Fever in under 5s: assessment and initial management, NICE guideline NG143, 2019. Kaufman, et al. British Journal of General Practice, 2019. John, et al. Clinical Microbiology and Infection, 2022. Robinson, et al. Paediatric & Child Health, 2014.
Baker et al. (Tue,) studied this question.