Related Experiment Video
Updated: Jul 7, 2025
Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
Published on: March 1, 2024
Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms
Kazuki Iio1, Naoaki Mikami2, Ryoko Harada2
1From the Division of Pediatric Emergency Medicine.
Insights
Febrile infants with urinary tract infections (UTIs) and respiratory symptoms experience delayed antibiotic treatment. Pediatricians should consider UTI in infants presenting with respiratory symptoms.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Febrile urinary tract infection (UTI) is common in infants.
- Respiratory symptoms can mask or be mistaken for UTI symptoms.
- Timely antibiotic treatment is crucial for preventing complications.
Purpose of the Study:
- To determine if febrile infants with respiratory symptoms have delayed antibiotic treatment for UTI compared to those without.
- To identify potential delays in UTI diagnosis and treatment in infants with concurrent respiratory illness.
Main Methods:
- Retrospective chart review of 214 infants (2-24 months) diagnosed with UTI.
- Exclusion of patients with congenital anomalies or prior febrile UTI.
- Comparison of time to first antibiotic treatment between infants with and without respiratory symptoms (cough, rhinorrhea, pharyngeal hyperemia, otitis media).
- Analysis using Cox regression to adjust for confounders like age and sex.
Main Results:
- Infants with respiratory symptoms had significantly longer time to first antibiotic treatment (51 hours vs. 21 hours).
- Respiratory symptoms were independently associated with delayed treatment (HR=0.63, 95% CI: 0.47-0.84).
- 104 patients had respiratory symptoms, and 110 did not.
Conclusions:
- Febrile UTI treatment is often delayed in infants presenting with respiratory symptoms.
- Pediatricians must maintain a high index of suspicion for UTI in infants with respiratory symptoms.
- Early diagnosis and treatment of UTI in infants are essential regardless of accompanying symptoms.
Objective:
To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without.
Study Design:
Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders.
Results:
A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (interquartile range: 3.0-8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptom and no respiratory symptom groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio = 0.63, 95% confidence interval: 0.47-0.84).
Conclusions:
Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.
Related Concept Videos
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26Tonsillitis II: Management
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....