UMEM Educational Pearls

Title: Pediatric Urinary Tract Infections (UTI) (submitted by Marina Kloyzner, MD)

Keywords: UTI, Fever, febrile, AAP, clinical practice guideline (PubMed Search)

Posted: 10/23/2015 by Mimi Lu, MD
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Fever is the most common presenting symptoms to pediatric emergency departments 10-20%

Of these, 2%-7% have a final diagnosis of a urinary tract infection (UTI).

Timely diagnosis and treatment of UTI is important in the pediatric population as it can progress to pyelonephrits which can lead to scarring of the renal parenchyma and end stage renal disease.

A challenge for the ED physician is whether or not to pursue the diagnosis of UTI in a febrile child with viral URI. However, multiple studies have shown that having a documented URI does not significantly decrease the chance of having a concomitant UTI. Furtheremore, there is a correletion betweent having RSV bronchiolitis with fever and a concurrent UTI.

The latest definition of UTI from the American Academy of Pediatrics (AAP) requires both a urinalysis with pyuria or bacteria and a urine culture with more than 50,000 CFU/mL.

Methods for collecting urine include urethral catheterization, suprapubic aspiration, clean catch collection and sterile urine bag.

Contamination rates for these methods are as follows:

Urine bag 46%
Clean catch 14-26%
Catheterization 12-14%
Suprapubic aspiration 1-9%

Because of the significant rates of contamination, catheterization and suprapubic aspiration are the recommended methods of obtaining urine in children younger than 3 years old.

References

Singh S., Sandelich S., Current Status of the Diagnosis and Treatment of Pediatric Urinary Tract Infections. Pediatric Emergency Medicine Reports 2014;19(2):13-22.

Roberts KB, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infactns and children 2 to 24 months. Pediatrics. 2011 Sept; 128(3):595-610.