[Evaluation of the quality of management of urinary infections in children in ambulatory care]. / Evaluation de la qualité de la prise en charge de l'infection urinaire de l'enfant en médecine ambulatoire.

The objective of this study was to describe the conditions in which urinary tract infections in children are managed by ambulatory medical services 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 involving 26 prescribing physicians in order to assess treatment and additional testing on 28 children whose urine cultures showed significant bacterial growth. Urine samples were collected at home by parents in 72% of the cases, often with defective procedures: improper antisepsis for pre-collection cleansing in 65% of the cases, in 51% of the cases the maximum time lapse between the moment a collection-bag was applied and the moment the filled bag was removed was overrun. Compared with standard techniques, the quality of the samples was deemed questionable in 33% of cases and unacceptable in 41%. Attending physicians diagnosed urinary infections in 22 children. The antibiotic treatment prescribed to these children was apparently insufficient in 40% of the cases. Less than a third of the infected children benefited from a radiologic examination of the urinary tract. This study demonstrates that adherence to rules inherent in managing pediatric urinary infections is less than satisfactory in ambulatory medicine. It appears necessary to improve the quality of urinalysis by inciting laboratories to collect urine samples in laboratory. Physicians should also be better informed of the results of consensus conferences.