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Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

Wing-Yee Kwok1*, Marjolein CE de Kwaadsteniet1, Mirjam Harmsen2, Lisette WA van Suijlekom-Smit3, François G Schellevis4 and Johannes C van der Wouden1

Author Affiliations

1 Department of General Practice, Erasmus MC - University Medical Center Rotterdam, PO Box 1738, 3000 DR, Rotterdam The Netherlands

2 Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands

3 Department of Paediatrics, Erasmus MC - University Medical Center/Sophia Children's Hospital, PO Box 1738, 3000 DR Rotterdam, The Netherlands

4 Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN Utrechtt the Netherlands

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BMC Pediatrics 2006, 6:10  doi:10.1186/1471-2431-6-10

Published: 4 April 2006



We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections.


During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral.


The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred.


This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral.