Diagnosing Urinary Tract Infection in Children

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Diagnosing Urinary Tract Infection in Children

Certain symptoms and signs increase the likelihood that a child has a UTI.

Urinary tract infections (UTIs) account for 5% to 14% of visits to pediatric emergency departments in the U.S. Researchers evaluated the diagnostic accuracy of various symptoms and signs of UTI in infants (aged 0–24 months) and children (aged 2–15 years) using pooled data from 12 studies (involving nearly 9000 patients) identified in a search of the medical literature from 1966 through 2007.

UTI was defined as recovery of any organism from a suprapubic specimen, or presence of at least 50,000 colony-forming units (CFUs)/mL from a catheterized urine specimen, or presence of at least 100,000 CFUs/mL from a clean-catch urine specimen. In infants with fever, the findings that were most useful for identifying patients with UTIs were history of UTI (likelihood ratio [LR] range, 2.3–2.9), temperature >40°C (LR range, 3.2–3.3), and suprapubic tenderness (LR, 4.4). Lack of circumcision also increased the likelihood of UTI in infants (summary LR, 2.8). In infants, the combination of temperature >39°C for more than 48 hours and no alternative source of fever on physical examination yielded an LR of 4.0. In children aged 2 to 15 years, the likelihood of UTI increased with the presence of abdominal pain (LR, 6.3); new-onset urinary incontinence (LR, 4.6); back pain (LR, 3.6); and dysuria, urinary frequency, or both (LR range, 2.2–2.8).

Comment: Failure to diagnose UTI in children can lead to renal scarring, hypertension, and end-stage renal disease. The findings of this study can help emergency physicians determine the probability of UTI based on the presence or absence of specific symptoms and signs. Pending culture results, empiric antibiotics are advisable for pediatric patients who have a reasonable risk for UTI, which is in sharp contrast to the use of empiric antibiotics in pediatric patients with upper respiratory infection and "bronchitis," for whom antibiotics are mostly useless but often prescribed.

— John A. Marx, MD, FAAEM, FACEP

Published in Journal Watch Emergency Medicine February 15, 2008

Citation(s):

Shaikh N et al. Does this child have a urinary tract infection? JAMA 2007 Dec 26; 298:2895.

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