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Management of febrile children with urinary tract infections
D S Nelson1, M B Gurr, J E Schunk
1Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City 84113, USA.
Insights
Most children with fever and urinary tract infections (UTI) can be treated as outpatients. Higher initial temperatures, over 40°C, indicate a higher risk for outpatient treatment failure in pediatric UTI cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Urinary tract infections (UTIs) are common in children, often presenting with fever.
- Management strategies vary, impacting treatment outcomes and healthcare resource utilization.
Purpose of the Study:
- To identify factors influencing admission, outpatient treatment, and treatment failure in children diagnosed with fever and UTI.
- To guide clinical decision-making for managing pediatric UTIs.
Main Methods:
- Retrospective chart review of children aged 3 months to 16 years.
- Inclusion criteria: emergency department diagnosis of cystitis, pyelonephritis, or UTI; positive urine culture; fever >38°C.
- Analysis of demographic, clinical, and treatment data for 69 patients.
Main Results:
- 19% of children were initially admitted; younger age (<2 years) was associated with admission.
- Of those discharged, 63% received parenteral antibiotics followed by oral antibiotics.
- 9% of outpatients failed treatment, associated with higher initial temperatures (median 40.1°C vs 39.2°C).
Conclusions:
- Most children with fever and UTI can be managed effectively on an outpatient basis.
- Children with initial temperatures ≥40°C face an increased risk of outpatient treatment failure.
- Age and antibiotic choice did not significantly predict outpatient failure, highlighting temperature as a key risk factor.
Abstract:
This study of the management of children with fever and urinary tract infection (UTI) was conducted to identify factors associated with initial admission, outpatient treatment, and outpatient treatment failure. A retrospective chart review identified children 3 months to 16 years of age with an emergency department (ED) diagnosis of cystitis, pyelonephritis, or UTI, a positive urine culture, and an ED temperature of >38 degrees C. Sixty-nine patients (90% female) were studied; 19% were admitted initially. Age younger than 2 years was associated with admission (P < .001). Of those initially discharged, 63% received parenteral antibiotics (usually intramuscular ceftriaxone), followed by oral antibiotics; 9% failed outpatient treatment. Outpatient failure was associated with higher initial temperatures (median 40.1 degrees C v 39.2 degrees C, P=.03, Mann-Whitney U) but was unrelated to age, initial white blood cell count, or use of parenteral antibiotics. These results indicate that most children with fever and UTI do not require hospital admission; those with temperatures of > or = 40 degrees C are at increased risk for outpatient failure.