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Urinary tract infections (UTI)

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

Clinical classification of UTIs in children

Severe UTI                

  • Fever ≥39°C             
  • Persistent vomiting    
  • Serious dehydration    
  • Poor treatment compliance 

Simple UTI

  • Mild pyrexia
  • Good fluid intake
  • Slight dehydration
  • Good treatment compliance

European Society of Paediatric Urology (2013)   

  • Advice and information on prompt recognition of symptoms, prevention, reasons and arrangements for long-term management if required
  • Education and encouragement to drink adequate amount
  • Children who have had a UTI should have ready access to clean toilets when required and should not be expected to delay voiding
  • Blood pressure levels for boys and girls by age and height percentile
  • Paediatric surgery registrars at Queensland Children's Hospital and GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local general paediatric service or general surgery services
    • Queensland Children's Hospital: 07 3068 1111
    • GCUH: 1300 744 284

Minimum referral criteria (Does your patient meet the minimum criteria?)

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark “urgent” on your referral

  • Child with known renal tract abnormalities
  • Significant neonatal renal pelvic dilatation (>15mm or >10mm if bilateral)
  • Concerns regarding obstruction

The following conditions could be referred to general paediatrics or paediatric surgery depending on the service and underlying condition

  • Infants and children > 3 months with history of acute pyelonephritis/upper urinary tract infection
  • Infants ≤ 6 months presenting with 1st UTI (after acute episode)
Category 2
(appointment within 90 calendar days)
  • Recurrent UTI with abnormal imaging results not category one
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Find assessment and management information at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Urinary tract infections (UTI) referrals (Referral will be returned without this)

  • Evaluate adequacy of urinary stream
  • MSU MCS results (clean catch)
    • infants and children presenting with unexplained fever of 38°C or higher should have a urine sample tested after 24 hours at the latest
  • Renal tract USS results
    • <1 year old first UTI
    • children of any age with recurrent UTI
    • children any age with an atypical UTI or UTI responding poorly to treatment

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Urinary tract infections (UTI) referrals

Highly desirable information – may change triage category

  • Frequency of urinary tract infections and age of first onset
  • A reliable urine specimen is vital to confirm the diagnosis – urine bags must not be used (high false positive rate)
  • Urinalysis (dipstick)

Desirable information – will assist at consultation

  • History of constipation, fluid intake, poor hygiene
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (esp. parents mental health, family violence, housing and financial stress, department of child safety involvement)
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports (high false positive rate)

Emergency Immediate transfer to the Emergency Department

If any of the following are present or suspected, please refer the patient to emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region

Paediatric surgery registrars at Queensland Children's Hospital/ GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

  • Queensland Children's Hospital: 07 3068 1111
  • GCUH: 1300 744 284

Urinary tract infections (UTI)

  • Acute infant urinary tract infection presenting septicaemia or acutely unwell
  • Hypertension > 97 percentile for age and/or height
  • Presumed UTI in infant <3 months

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 17 November 2022