Nonresponders: Prolonged Fever Among Infants With Urinary Tract Infections

Abstract

ABSTRACT. Background. The majority of young children with fever and urinary tract infections (UTIs) have evidence of pyelonephritis based on renal scans. Resolution of fever during treatment is 1 clinical marker of adequate treatment. Theoretically, prolonged fever may be a clue to complications, such as urinary obstruction or renal abscess.Objective. Describe the pattern of fever in febrile children undergoing treatment of a UTI. Compare the clinical characteristics of those patients with prolonged fever to those who respond faster to therapy.Setting. An urban pediatric hospital. Design. Medical record review. Methods. All children <2 years old admitted to the pediatric service with a primary discharge diagnosis of pyelonephritis or UTI were reviewed for 65 consecutive months. Patients with previous UTI, known urologic problems, or immunodeficiency were excluded. Only patients with an admitting temperature >38°C and those who met standard culture criteria were studied. Temperatures are not recorded hourly on the inpatient unit; therefore, they were assigned to blocks of time. Nonresponders were defined as those above the 90th percentile for the time to defervesce. Nonresponders were then compared with the balance of the study patients, termed responders.Results. Of 288 patients studied, the median age was 5.6 months (interquartile range: 1.3-7.9 months old). Median admission temperature was 39.3°C (interquartile range: 38.5°C-40.1°C). Median time to defervesce ranged in the time block 13 to 16 hours. Sixty-eight percent were afebrile by 24 hours and 89% by 48 hours. Thirty-one patients had fever >48 hours (nonresponders). Nonresponders were older than responders ( ABBREVIATIONS. UTI, urinary tract infection; IQR, interquartile range; CI, confidence interval; WBC, white blood cell.

Follow-up Urine Cultures and Fever in Children With Urinary Tract Infection

“…The study by Bachur 11 provided us with some of these answers. He showed that of 288 children 2 years and younger, 11% were still febrile beyond 48 hours of therapy.…”

“…Fever was defined as a body temperature of Ն38.0°C for rectal or oral temperatures and Ն37.0°C for axillary temperatures. [11][12][13] Since temperatures…”

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

“…[1][2][3] Clinical practice guidelines exist for the diagnosis and management of UTIs in young children 4 but do not include recommendations regarding when to obtain blood cultures in children with suspected UTI or appropriate treatment regimens for infants with UTI and bacteremia, which generates considerable uncertainty over how to manage these infants. Several studies have demonstrated that bacteremia occurs infrequently in children with UTIs [5][6][7][8][9] and that children with bacteremia are diffi cult to distinguish clinically from children with nonbacteremic UTIs. 5,7,8,10 However, because bacteremic UTI is the most common cause of bacteremia in infants, it is important to examine treatment regimens for this clinical entity and how they relate to clinical outcomes.…”

“…Several studies have demonstrated that bacteremia occurs infrequently in children with UTIs [5][6][7][8][9] and that children with bacteremia are diffi cult to distinguish clinically from children with nonbacteremic UTIs. 5,7,8,10 However, because bacteremic UTI is the most common cause of bacteremia in infants, it is important to examine treatment regimens for this clinical entity and how they relate to clinical outcomes. 11 There is a growing body of evidence suggesting that long courses of intravenous (IV) antibiotics may not be necessary for even the youngest infants with UTIs.…”

Infección urinaria en pediatría: controversias

“…El otro 11% (no respondedores) tuvo una similar frecuencia de bacteriemias, hidronefrosis ecográfi cas, abscesos renales y refl ujo vesico-ureteral (RVU) signifi cativo que los respondedores. Todos los urocultivos controles fueron negativos 29 .…”