Can absence of pyuria exclude urinary tract infection in febrile infants? About 2011 AAP guidelines on UTI
Related Experiment Videos
Seong Heon Kim1,2, Soo Young Lyu1, Hye Young Kim3
1Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
Insights
Urinary tract infection (UTI) in young children can occur without significant pyuria. Absence of pyuria does not rule out UTI in children aged 2-24 months, necessitating careful clinical evaluation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in infants and young children.
- Diagnosis can be challenging in the absence of significant pyuria.
- This study focuses on febrile UTI in children aged 2-24 months.
Purpose of the Study:
- To describe the clinical and laboratory features of UTI in young children presenting without significant pyuria.
- To evaluate the diagnostic challenges posed by UTI cases lacking pyuria.
Main Methods:
- Retrospective analysis of febrile UTI cases in children aged 2-24 months.
- Comparison of patients with definite UTI (Group A, n=283) and presumed UTI without pyuria (Group B, n=19).
- Inclusion of clinical data, laboratory results, and imaging findings.
Main Results:
- Group B patients presented with shorter fever duration (17.7 vs 34.5 hours) and sought care within 24 hours more frequently (89.5%).
- Similar rates of acute scintigraphic lesions were observed in both groups (47.8% vs 50%).
- No significant difference in underlying urological abnormalities between groups (24.5% vs 33.3%).
Conclusions:
- Absence of pyuria should not exclude the possibility of UTI in young children.
- Clinical suspicion remains crucial for diagnosing UTI in this age group.
- Further investigation is warranted for febrile infants and young children even without pyuria.
Background:
The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2-24 months.
Methods:
The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection.
Results:
Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B (P = 0.74).
Conclusions:
Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2-24 months.