Morbidity following urinary tract infection in young children: an electronic record-linked cohort study

The aims of this project are to determine the medium and longer term outcomes following urinary tract infection (UTI) diagnosed in childhood in primary care.

Also to determine whether UTI identified through systematic sampling in primary care is different to UTI identified through standard practice (sampling led by clinician suspicion) in primary care in terms of short, medium and long term morbidity.

The results of this study will inform urine sampling practice in acutely ill children in routine primary care.

Objectives:

a) In children identified through standard practice:

i) Identify a cohort of children who presented with an acute illness in primary care aged less than five years old; using population based routinely collected data.
ii) Identify within that cohort children with a microbiologically confirmed UTI when they were aged less than five years old.
iii) Describe the presenting features for children with and without UTI in terms of age, gender and presenting symptom or working diagnosis from general practice records.
iv) Describe the initial management for children with and without UTI in terms of antibiotic treatment, hospital admission and repeat urine sampling from general practice records.
v) Describe the short term (up to 12 months) and medium term (12 months - four years) clinical outcomes including GP re-consultation, hospital admission, antibiotic prescribing, subsequent urine sampling, recurrent UTIs, dysfunctional voiding syndromes, imaging of the renal tract, renal scarring, vesicoureteric reflux (VUR), hypertension, chronic kidney disease and renal failure using general practice and hospital records.
vi) Where available, describe longer term outcomes (more than four years later) including recurrent UTIs, dysfunctional voiding syndromes, imaging of the renal tract, renal scarring, VUR, hypertension, chronic kidney disease, pre-eclampsia and renal failure using general practice and hospital records.

b) In children identified through systematic sampling:

i) Describe the initial management of UTI in terms of antibiotic treatment, hospital admission and repeat urine sampling from general practice records.
ii) Describe the short term (up to 12 months) and medium term (12 months- 4 years) clinical outcomes including GP re-consultation, hospital admission, antibiotic prescribing, subsequent urine sampling, recurrent UTIs, dysfunctional voiding syndromes, imaging of the renal tract, renal scarring, vesicoureteric reflux (VUR), hypertension, chronic kidney disease and renal failure using general practice and hospital records.

c) Comparisons:

i) Compare the presenting features of UTI identified through standard practice with UTI identified through systematic urine sampling.
ii) Compare the initial management of UTI identified through standard practice with UTI identified through systematic urine sampling.
iii) Compare the short-term (up to one year) outcomes of UTI identified through standard practice with UTI identified through systematic urine sampling.
iv) Compare the medium-term (one-four years) outcomes of UTI identified through standard practice with UTI identified through systematic urine sampling.
v) Compare (where available) blood pressure and creatinine levels in those with a history of UTI identified through standard practice with UTI identified through systematic urine sampling.
vi) Compare (where available) blood pressure and creatinine levels in those with a history of childhood UTI with those without a history of childhood UTI identified through standard practice.
vii) Assess the validity of using routine GP data for the diagnosis of UTI by comparing GP diagnosis with microbiological culture.
viii) Assess the validity of using routine GP data for presenting features and acute management of UTI by comparing the GP record data with study data for DUTY and EURICA study participants.