Prevalence of urinary tract infection in febrile infants

• Published in: The Journal of pediatrics Vol. 123; no. 1; pp. 17 - 23
• Main Authors: Hoberman, Alejandro, Chao, Han-Pu, Keller, David M., Hickey, Robert, Davis, Holly W., Ellis, Demetrius
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.1993; Elsevier
• Subjects: Bacteria - isolation & purification; Bacteriuria - complications; Bacteriuria - epidemiology; Bacteriuria - microbiology; Bacteriuria - urine; Biological and medical sciences; Chi-Square Distribution; Female; Fever - epidemiology; Fever - etiology; Fever - microbiology; Fever - urine; Follow-Up Studies; Humans; Infant; Linear Models; Male; Medical sciences; Nephrology. Urinary tract diseases; Prevalence; Pyuria - complications; Pyuria - epidemiology; Pyuria - microbiology; Pyuria - urine; Sensitivity and Specificity; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract Infections - complications; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Urinary Tract Infections - urine; Urinary tract. Prostate gland; Human; Urinary system disease; Prevalence; Sex; Renal disease; Infant; Urinary tract disease; Urinary tract; Fever; Ascending pyelonephritis; Infection; Pyelonephritis; Race; Diagnosis; Hyperthermia; Comparative study
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(05)81531-8

Urinary tract infection (UTI), a relatively common cause of fever in infancy, usually consists of pyelonephritis and may cause permanent renal damage. This study assessed (1) the prevalence of UTI in febrile infants (temperature≥38.3°C) with differing demographic and clinical characteristics and (2) the usefulness of urinalysis in diagnosing UTI. We diagnosed UTI in 50 (5.3%) of 945 febrile infants if we found ≥10,000 colony-forming units of a single pathogen per milliliter in a urine specimen obtained by catheterization. Prevalences were similar in (1) infants aged ≤2 months undergoing examination for sepsis (4.6%), (2) infants aged >2 months in whom UTI was suspected, usually because no source of fever was apparent (5.9%), and (3) infants with no suspected UTI, most of whom had other illnesses (5.1%). Female and white infants had significantly more UTIs, respectively, than male and black infants. In all, 17% of white female infants with temperature ≥39°C had UTI, significantly more ( p<0.05) than any other grouping of infants by sex, race, and temperature. Febrile infants with no apparent source of fever were twice as likely to have UTI (7.5%) as those with a possible source of fever such as otitis media (3.5%) ( p=0.02). Only 1 (1.6%) of 62 subjects with an unequivocal source of fever, such as meningitis, had UTI. As indicators of UTI, pyuria and bacteriuria had sensitivities of 54% and 86% and specificities of 96% and 63%, respectively. In infants with fever, clinicians should consider UTI a potential source and consider a urine culture as part of the diagnostic evaluation.