GPs’ perspectives on diagnosing childhood urinary tract infections: a qualitative study

Background: Diagnosis and management of childhood urinary tract infections (UTI) is challenging in general practice, because of a range of factors. Aim: To explore general practitioners’ perspectives concerning the barriers and facilitators for diagnosis and management of childhood UTI. Design and setting: Qualitative study in general practice, Belgium. Method: Semi-structured interviews with 23 general practitioners from January 2021 to June 2021. Interviews were video- and audio recorded, transcribed verbatim and analyzed using a thematic approach. Results: The barriers for early diagnosis of UTI were the assumption of low UTI prevalence and aspecific presentation of UTI in children, difficulties in urine collection, and diagnostic uncertainty. All GPs indicated they sampled urine in either children with specific UTI features (dysuria, abdominal pain), or unexplained fever. Facilitators for UTI screening were instructional material for parents, skill training for GPs, additional nursing staff, novel noninvasive convenient collection methods, online decision support informing parents when to bring a urine sample to the consultation and an accurate easy-to-use point-of-care test for UTI. Empirical antibiotic treatment was initiated based on dipstick test results, clinical features suggestive of UTI, severity of illness, gut feeling, long duration of fever, time of the day and parents’ ability to judge disease severity. Conclusion: The assumption of a low UTI prevalence, absence of obvious UTI features and difficult urine sampling might cause childhood UTIs to go undetected in general practice. Diagnostic uncertainty makes appropriate treatment challenging.