 The overall prevalence of UTI is approximately 2.1 percent in febrile infants but varies widely by race and sex.  Caucasian children have a two- to fourfold higher prevalence of UTI as compared to African-American and Hispanic children  Females have a two- to fourfold higher prevalence of UTI than do males  Caucasian females with a temperature of 39 ºC have a UTI prevalence of 13 percent

 Most common source of serious bacterial infection in children < 2 years  It is a diagnostic challenge by history and physical exam alone  Infants less than 2 years have non specific symptoms

 Easy  Quick to perform  Inexpensive

 Common practice › young febrile infants who do not have an obvious source of infection  Requires an invasive procedure.

 Comparison of rapid tests and screening strategies for detecting UTI in infants  Cross-sectional study  3873 children <2 years of age who had a urine culture obtained in the ED by urethral catheterization

 Urine dipstick tests  leukocyte esterase or nitrites  Enhanced urinalysis  (UA) (urine white blood cell count/mm3 plus Gram stain)  Compared with urine culture results

 Test positive for nitrite and leucocyte › Specificity of 97%  Test negative for nitrite, LE › Sensitivity of 80%  However, the enhanced UA was the most sensitive (97%) at detecting UTI  Enhanced UA is the preferred method

 A 15 month old female presents with a 2 day history of fever to 40 degrees Celsius and mild URI symptoms. Otherwise she appears healthy.  You suspect a possible UTI. The parents are concerned about the invasiveness of a urine catheterization and do not want to cause harm to their child if the odds of an infection are low.  What are your options at this point?  Can you do a bag U/A as a screen?

 Retrospective Study  Children younger than 2 years with fever (38°C) seen in the emergency department during a period of 65 months  Clinical situation that necessitates the collection of a urine culture

 Medical records of 37,450 febrile children younger than 2 years were reviewed  Forty-four percent were females  Median age was 10.6 months  Median temperature was 38.8°C

 The sensitivity of the UA was 82%  The specificity of UA was 92%  A negative UA result decreases the odds of a UTI 5-fold

 If the Prevalence of UTI is less than 2% The risk of missing a UTI because of a false-negative UA result is "acceptable.  1 UTI would be missed for every 250 febrile infants screened by UA

 Age and Sex  Males younger than 6 months 5.8%  Males older > than 6 months.6%  Females younger than 1 year 3.1 %

 Ethnicity  White Females 5%  Hispanic Males 2.2%  Temperature greater than or equal to 39°C  Females 3.8%

 A 5 month male presents with a 2 day history of fever to 38 degrees Celsius and mild URI symptoms. Otherwise he appears healthy.  Prevalence is 3 %

 Urine Culture should be obtained

 A 7 month male presents with a 2 day history of fever to 38 degrees Celsius and mild URI symptoms. Otherwise he appears healthy.  Prevalence is.6 %

 Consider pre-screening with a Bag UA?

 A 15 month old white female presents with a 2 day history of fever to 38 degrees Celsius and mild URI symptoms. Otherwise she appears healthy.  Prevalence is 3.1 %

 Urine Culture should be obtained

 A 15 month old Hispanic or black female presents with a 2 day history of fever to 38 degrees Celsius and mild URI symptoms. Otherwise she appears healthy  Prevalence.2 %

 Consider pre-screening with a Bag UA?

 This study suggest that dipstick UA can be used as a screening tool  Offers a recommendation based on prevalence as to when to obtain a urine culture.  If the Prevalence of UTI is less than 2% The risk of missing a UTI because of a false-negative UA result is "acceptable  These patients can then be excluded from further investigation, without the need for confirmatory culture

 Bachur R, Harper MB. Reliability of the urinalysis for predicting urinary tract infections in young febrile Division of Emergency Medicine, Arch Pediatr Adolesc Med Jan;155(1):60-5.  Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics Aug; 102(2):e16.  Shaw KN, Gorelick M. Urinary tract infection in the pediatric patient. Pediatr Clin North Am Dec;46(6): , vi.  Hoberman A, Urinary tract infections in young febrile children. Pediatr Infect Dis J Jan; 16(1):11-7.  Schlager TA. Urinary tract infections in children younger than 5 years of age: epidemiology, diagnosis, treatment, outcomes and prevention. Paediatr Drugs 2001; 3(3):