Urine Testing and Urinary Tract Infections in Febrile Infants Seen in Office Settings

Newman, Thomas B.; Bernzweig, Jane; Takayama, John I.; Finch, Stacia; Wasserman, Richard C.; Pantell, Robert H.

doi:10.1001/archpedi.156.1.44

Cited by 145 publications

(123 citation statements)

References 29 publications

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“…This fi nding confi rms previous studies suggesting that children with bacteremic UTI show no major clinical differences from those with nonbacteremic UTI at presentation. 6,9,10,20 Bacteremic infants were no more likely to have abnormal urinary imaging results. However, selective ordering of urinary imaging may have biased this fi nding.…”

Section: Discussionmentioning

confidence: 97%

“…Our fi nding that the risk of bacteremia with UTI is inverse to age and quite low beyond 6 months confi rms previous results. 6,8,20,21 There are no published recommendations for a threshold pretest probability at which to obtain a blood culture in an infant with suspected UTI. Theoretically, the detection of bacteremia may be benefi cial if the extended hospitalizations and courses of parenteral antibiotics prevent a complication such as meningitis or recurrent UTI.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Román

Chang

Schroeder

2015

Hospital Pediatrics

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Objectives: To report the prevalence of bacteremia by age in a sample of infants <1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia. Methods: We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs. Results: We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%–5.3%) for all UTIs and 8% (95% confidence interval 6.1%–10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P < .001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge. Conclusions: Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Román

Chang

Schroeder

2015

Hospital Pediatrics

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“…These benefits are not known and probably are not uniform; the younger and sicker an infant is and the longer he or she has been febrile, the greater the likely benefit of diagnosing and treating a UTI. Because acute symptoms of most UTIs seem to resolve un-eventfully, even without treatment, 5,6 some of the impetus for diagnosing UTIs rests on the belief that doing so will reduce the risk of renal scarring and associated sequelae. 7 This belief needs to be proven, and the benefit quantified, if a urine-testing threshold is to be evidence-based.…”

Section: Which Children Should Have Their Urine Tested?mentioning

confidence: 99%

The New American Academy of Pediatrics Urinary Tract Infection Guideline

Newman

2011

Pediatrics

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106

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This issue of Pediatrics includes a long-awaited update 1 of the American Academy of Pediatrics (AAP) 1999 urinary tract infection (UTI) practice parameter. 2 The new guideline is accompanied by a technical report 3 that provides a comprehensive literature review and also a new meta-analysis, for which the authors obtained individual-level data from investigators. The result is an exceptionally evidence-based guideline that differs in important ways from the 1999 guideline and sets a high standard for transparency and scholarship.

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“…12 Studies on variation and adherence to existing practice guidelines for evaluation and management of fever in young infants have been limited to surveys or adherence to recommended urine testing or have excluded neonates 0-28 days of age. [13][14][15] Belfer et al 16 conducted a survey-based study on compliance with guidelines for the management of febrile infants and found 54% compliance among pediatric emergency medicine directors. To our knowledge, no large multi-institutional study has reported actual practice for the management of febrile neonates in terms of variation and adherence to standard recommendations in pediatric emergency departments (PEDs) in the United States.…”

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Management of Febrile Neonates in US Pediatric Emergency Departments

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Recommended management of febrile neonates (#28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments. WHAT THIS STUDY ADDS:There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations. abstract BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS:Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS:Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P , .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management.CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.

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Urine Testing and Urinary Tract Infections in Febrile Infants Seen in Office Settings

Cited by 145 publications

References 29 publications

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

The New American Academy of Pediatrics Urinary Tract Infection Guideline

Management of Febrile Neonates in US Pediatric Emergency Departments

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