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Urinary tract infection — DCH MCQ

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HardCommon childhood illnessesUrinary tract infectionDCH

A previously well 5-year-old girl presents with a temperature of 39.1°C, dysuria and new daytime wetting. This is her first suspected urinary tract infection. She is not seriously ill, has normal urine flow, no abdominal or bladder mass, no loin tenderness and a normal serum creatinine. A fresh clean-catch urine sample is positive for both nitrite and leucocyte esterase. Which single investigation is indicated at this presentation?

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Correct answer: A — Send the clean-catch urine sample for culture and susceptibility testing

The correct answer is A. Nitrite and leucocyte esterase positivity supports a UTI, and fever of at least 38°C makes this a suspected acute upper UTI under NICE criteria. A clean-catch sample should therefore be sent for culture and susceptibility testing, ideally before antibiotics are started. Acute ultrasound is reserved for atypical UTI, such as serious illness, poor urine flow, a mass, raised creatinine, septicaemia or failure to improve within 48 hours. In a child aged 3 years or older, ultrasound within 6 weeks and a later DMSA scan are indicated for recurrent rather than uncomplicated first-time UTI. MCUG is not routinely recommended in this age group.

Reference: NICE guideline NG224, Urinary tract infection in under 16s: diagnosis and management, sections 1.1.11–1.1.25 and Table 6, 2022. https://www.nice.org.uk/guidance/ng224/chapter/Recommendations