ASSESSMENT OF THE QUALITY OF URINARY-TRAC T INFECTION MANAGEMENT IN AMBULATORY MEDICINE

The objective of this study was to describe the conditions in which ur inary tract infections in children are managed by ambulatory medical s ervices and compare the results with recommendations of experts in the field. For a period of one month, we focused on the methods of urine sample collection by observing 149 urinalyses for children under 15 in 13 private medical laboratories. Secondly, we investigated cases invo lving 26 prescribing physicians in order to assess treatment and addit ional testing on 28 children whose urine cultures showed significant b acterial growth. Urine samples were collected at home by parents in 72 % of the cases, often with defective procedures: improper antisepsis f or pre-collection cleansing in 65% of the cases, in 51% of the cases t he maximum time lapse between the moment a collection-bag was applied and the moment the filled bag was removed was overran. Compared with s tandard techniques, the quality of the samples was deemed questionable in 33% of cases and unacceptable in 41%. Attending physicians diagnos ed urinary infections in 22 children. The antibiotic treatment prescri bed to these children was apparently insufficient in 40% of the cases. Less than a third of the infected children benefited from a radiologi c examination of the urinary tract. This study demonstrates that adher ence to rules inherent in managing pediatric urinary infections is les s than satisfactory in ambulatory medecine. It appears necessary to im prove the quality of urinalysis by inciting laboratories to collect ur ine samples in laboratory. Physicians should also be better informed o f the results of consensus conferences.