Microbiological aspects of the UK National Institute for Health and Clinical Excellence (NICE) guidance on urinary tract infection in children

The publication in August 2007 of the UK National Institute for Health and Clinical Excellence (NICE) guidance on urinary tract infection in children provided a fresh and useful review of the management of this condition. However, it has also resulted in some controversy. In particular, the advice to use urgent microscopy for rapid screening of urine in children >= 3 months but < 3 years of age has presented practical problems for some laboratories in staffing this service out of hours. Further discussion between microbiologists, paediatricians and primary care doctors regarding this recommendation is required. In addition, the abandoning of routine antibiotic prophylaxis following a first-time urine infection has caused some debate. The evidence around these issues is reviewed, as well as the differences in the laboratory processing and interpretation of paediatric urines compared with urine specimens from adults. General measures to reduce the risk of recurrence are also discussed. As mentioned in the NICE guidance, microbiologists should continue to emphasize the basic principles, particularly the importance of obtaining an accurate diagnosis from a well-collected and well-transported urine specimen.