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Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis
Marsha A Elkhunovich1, Vincent J Wang2, Phung Pham1
1From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Febrile infants with bronchiolitis have a significant incidence of urinary tract infections (UTIs). Testing for UTIs is recommended in this population, especially for uncircumcised males who show increased risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- The diagnostic utility of urinary tract infection (UTI) testing in febrile infants diagnosed with bronchiolitis remains unclear.
- Bronchiolitis is a common respiratory infection in infants, often presenting with fever.
Purpose of the Study:
- To determine the incidence of UTIs in febrile infants aged 2 to 12 months with bronchiolitis.
- To identify risk factors associated with UTIs in this specific pediatric population.
Main Methods:
- A prospective, multicenter, cross-sectional study involving 442 febrile infants with bronchiolitis.
- Data collected included patient demographics, fever characteristics, and UTI test results.
- Analysis focused on comparing UTI incidence with asymptomatic bacteriuria and identifying risk factors.
Main Results:
- A UTI incidence of 7.69% was observed in febrile infants with bronchiolitis.
- UTIs were not significantly correlated with age, fever severity, fever duration, or ethnicity.
- Uncircumcised males demonstrated a statistically significant higher likelihood of UTIs compared to circumcised males.
Conclusions:
- Febrile infants aged 2 to 12 months presenting with bronchiolitis exhibit a clinically relevant incidence of UTIs.
- Urinary tract infection evaluation should be considered for febrile infants with bronchiolitis, particularly uncircumcised males.
Background:
The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate.
Objective:
The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic bacteriuria and determine risk factors associated with UTIs in this population.
Methods:
This prospective multicenter cross-sectional study was conducted in the emergency departments of 6 children's hospitals between November 2011 and June 2015. We obtained a convenience sample of febrile infants with bronchiolitis 2 to 12 months of age who were tested for UTI. Patient characteristics analyzed included age, maximum temperature, duration of fever, ethnicity, sex, and circumcision status.
Results:
A total of 442 patients (including 86 from a previously published pilot study) were enrolled. Mean age was 5.5 months, 65.2% were Latino, 50.9% were male, and 27.6% of male infants were circumcised. Urinary tract infections were found in 33 patients (7.69%, binomial; 95% confidence interval [CI], 5.19%-10.33%). Urinary tract infections were not related to age, height of temperature, duration of fever, or ethnicity. Uncircumcised males were significantly more likely to have UTIs than circumcised males (7.64% vs 0%, P = 0.03). Odds ratios (ORs) were lower for circumcised males but not uncircumcised males when compared with females (OR, 0.12; CI, 0.0-0.71; P = 0.01 vs OR, 0.77; CI, 0.33-1.74; P = 0.64).
Conclusions:
Febrile infants 2 to 12 months of age with bronchiolitis have a clinically significant incidence of UTI, suggesting that UTI evaluation should be considered in these patients.
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