Effective Health Care: Diagnosing urinary tract infection in the under fives

Bulletin on the effectiveness of health service interventions for decision makers Bulletin on the effectiveness of health service interventions for decision makers ■ Urinary tract infection (UTI) is common in children under five. Children who are misdiagnosed can either fail to receive appropriate treatment or receive unnecessary treatment and investigation. ■ All of the tests commonly used for the diagnosis of UTI are carried out on urine samples. ■ A dipstick test which is positive for both nitrite and leukocyte esterase (LE) indicates a very high likelihood of a UTI. ■ Dipstick negative for LE and nitrite or microscopic analysis negative for pyuria and bacteriuria of a clean voided urine (CVU), bag or nappy/pad specimen can be used to rule out UTI, avoiding the need for further investigation for UTI. ■ Acute Tc-99m-DMSA remains the reference standard test for the localisation of UTI. ■ In the absence of evidence of any effect on patient outcome, universal imaging (e.g. micturating cystourethrography (MCUG) for reflux or dimercaptosuccinic acid scintigraphy (DMSA) for renal scarring) cannot be justified; referral should be on an individual patient basis. This bulletin summarises the research evidence for the diagnosis and evaluation of urinary tract infections in children under five years of age.