Meet RUPERT : A new UTI tool

	Rachel Fieldhouse DECIDING when to prescribe	cultures , say researchers from Melbourne ’ s Murdoch	guidelines for managing paediatric UTIs , says Associate	“ The idea behind this score is to try to help with that deci-
	IV antibiotics for UTIs in kids	Children ’ s Research Institute	Professor Penelope Bryant , a	sion — to say , for this child in
	could soon be made easier	( MCRI ).	paediatric infectious diseases	front of me right now with a
	thanks to Australian doctors	It relies on six clinical fea-	physician at MCRI and the	suspected UTI , do they really
	who have developed a world-	tures — rigors , urological	Royal Children ’ s Hospital in	need IV antibiotics and hospi-
	first individualised scoring	abnormalities , pyrexia , eme-	Melbourne .	tal admission or not ?”
	tool .	sis , recurrent UTIs and tach-	“ The guidelines that exist	Professor Bryant ’ s team ,
	Dubbed ‘ RUPERT ’, the	ycardia — with a cut-off score	are unnecessarily vague	which published its findings
	score can identify children	of 3 correctly identifying the	because there is just no evi-	in BMJ Open , defined and
	with complicated UTIs who	antibiotic route with 80 %	dence about what to do ,” she	validated the tool using ret-
Associate Professor Penelope Bryant .					would benefit from initial IV antibiotics without relying on blood tests or urine	accuracy . The decision support tool fills a gap in clinical	told Australian Doctor . “ They say things like , ‘ Use IV if thought to be necessary .’	rospective data for 831 children aged 1-11 years with confirmed UTIs who were
				prescribed either oral or IV
				antibiotics .
				After identifying the six
				features that could accurately
				predict which patients would
				likely fail oral antibiotics ,

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they determined that a cut-off score of 3 would reliably trigger IV antibiotic therapy .

Further testing in another 400 patients found that RUPERT could correctly identify

the antibiotic route for
children aged 1-11 years with
probable UTIs ( 82 % accuracy )
and those aged 12-17 years
with probable or confirmed
UTIs ( 86 % accuracy ).
‘ The guidelines that exist are unnecessarily vague .’

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However , it was less accurate for infants aged 3-11 months ( 64 % accuracy ), which the team attributed to frequent use of IV antibiotics “ without a clear clinical indication ”.

“ There is no pathophysiological reason that infants aged 3-11 months should be different to older children , but both our data … and previous studies have shown higher IV rates in this age group without clear clinical reasons ,” they wrote .

“ This , therefore , would benefit from prospective application and testing and could help reduce unnecessary IV in this age group .”

The researchers acknowledged the need for further validation in other settings given the score was only tested at a single ED .

Professor Bryant said this could include general practices .

“ Just like in ED , GPs are at the front line of making these decisions — often , without all the test results available ,” she said .

“ At a big tertiary children ’ s hospital , we see at least two kids every day with UTIs , and you would see a similar number or more in general practice because a lot of the kids who have UTIs do not end up in ED .”

BMJ Open 2024 ; 8 Jul .

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Australian Doctor 9th Aug Issue | Page 12

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Meet RUPERT : A new UTI tool

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