Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2–24 Months of Age
Publication Date: December 1, 2016
Last Updated: March 14, 2022
Action Statements
1. If a clinician decides that a febrile infant with no apparent source for the fever requires antimicrobial therapy to be administered because of ill appearance or another pressing reason, the clinician should ensure that a urine specimen is obtained for both culture and urinalysis before an antimicrobial is administered; the specimen needs to be obtained through catheterization or suprapubic aspiration (SPA), because the diagnosis of UTI cannot be established reliably through culture of urine collected in a bag. (A, )
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2. If a clinician assesses a febrile infant with no apparent source for the fever as not being so ill as to require immediate antimicrobial therapy, then the clinician should assess the likelihood of UTI.
2a. If the clinician determines the febrile infant to have a low likelihood of UTI, then clinical follow-up monitoring without testing is sufficient. (A, )
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2b. If the clinician determines that the febrile infant is not in a low-risk group (see below), then there are 2 choices: (A, )
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Option 1 is to obtain a urine specimen through catheterization or SPA for culture and urinalysis.
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Option 2 is to obtain a urine specimen through the most convenient means and to perform a urinalysis. If the urinalysis results suggest a UTI (positive leukocyte esterase test results or nitrite test or microscopic analysis results for leukocytes or bacteria), then a urine specimen should be obtained through catheterization or SPA and cultured; if urinalysis of fresh (less than 1 hour since void) urine yields negative leukocyte esterase and nitrite results, then it is reasonable to monitor the clinical course without initiating antimicrobial therapy, recognizing that a negative urinalysis does not rule out a UTI with certainty.
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3. To establish the diagnosis of UTI, clinicians should require both urinalysis results that suggest infection (pyuria and/or bacteriuria) and the presence of at least 50,000 colony-forming units (cfu) per milliliter of a uropathogen cultured from a urine specimen obtained through transurethral catheterization or SPA. (C, )
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4a. When initiating treatment, the clinician should base the choice of route of administration on practical considerations. Initiating treatment orally or parenterally is equally efficacious. The clinician should base the choice of agent on local antimicrobial sensitivity patterns (if available) and should adjust the choice according to sensitivity testing of the isolated uropathogen. (A, )
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4b. The clinician should choose 7 to 14 days as the duration of antimicrobial therapy. (B, )
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5. Febrile infants with UTIs should undergo renal and bladder ultrasonography (RBUS). (C, )
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6a. Voiding cystourethrography (VCUG) should not be performed routinely after the first febrile UTI. VCUG is indicated if RBUS reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances. (B, )
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6b. Further evaluation should be conducted if there is a recurrence of febrile UTI. (X, )
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7. After confirmation of UTI, the clinician should instruct parents or guardians to seek prompt medical evaluation (ideally within 48 hours) for future febrile illnesses to ensure that recurrent infections can be detected and treated promptly. (C, )
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Title
Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2–24 Months of Age
Authoring Organization
American Academy of Pediatrics
Publication Month/Year
December 1, 2016
Last Updated Month/Year
January 16, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide an updated review of the supporting evidence on febrile infant and young children with urinary tract infection (UTI)
Target Patient Population
Urinary Tract Infection in Febrile Infants and Young Children 2–24 Months of Age
Inclusion Criteria
Child, Infant
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management
Diseases/Conditions (MeSH)
D019072 - Antibiotic Prophylaxis, D014552 - Urinary Tract Infections, D005334 - Fever
Keywords
urinary tract infection (UTI), pediatric, antibiotic, urinary tract infection
Source Citation
Pediatrics December 2016, 138 (6) e20163026; DOI: https://doi.org/10.1542/peds.2016-3026