title: Prevalence of urinary tract infection in febrile infants.
abstract: Urinary tract infection (UTI), a relatively common cause of fever in infancy, usually consists of pyelonephritis and may cause permanent renal damage. This study assessed (1) the prevalence of UTI in febrile infants (temperature > or = 38.3 degrees C) with differing demographic and clinical characteristics and (2) the usefulness of urinalysis in diagnosing UTI. We diagnosed UTI in 50 (5.3%) of 945 febrile infants if we found > or = 10,000 colony-forming units of a single pathogen per milliliter in a urine specimen obtained by catheterization. Prevalences were similar in (1) infants aged < or = 2 months undergoing examination for sepsis (4.6%), (2) infants aged > 2 months in whom UTI was suspected, usually because no source of fever was apparent (5.9%), and (3) infants with no suspected UTI, most of whom had other illnesses (5.1%). Female and white infants had significantly more UTIs, respectively, than male and black infants. In all, 17% of white female infants with temperature > or = 39 degrees C had UTI, significantly more (p < 0.05) than any other grouping of infants by sex, race, and temperature. Febrile infants with no apparent source of fever were twice as likely to have UTI (7.5%) as those with a possible source of fever such as otitis media (3.5%) (p = 0.02). Only 1 (1.6%) of 62 subjects with an unequivocal source of fever, such as meningitis, had UTI. As indicators of UTI, pyuria and bacteriuria had sensitivities of 54% and 86% and specificities of 96% and 63%, respectively. In infants with fever, clinicians should consider UTI a potential source and consider a urine culture as part of the diagnostic evaluation.
authors.affiliation: Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213.
authors.forename: A
authors.initials: A
authors.lastname: Hoberman
authors.forename: H P
authors.initials: HP
authors.lastname: Chao
authors.forename: D M
authors.initials: DM
authors.lastname: Keller
authors.forename: R
authors.initials: R
authors.lastname: Hickey
authors.forename: H W
authors.initials: HW
authors.lastname: Davis
authors.forename: D
authors.initials: D
authors.lastname: Ellis
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D001437:Bacteriuria / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000652:urine; D016009:Chi-Square Distribution; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000652:urine; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D015995:Prevalence; D011776:Pyuria / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000652:urine; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000652:urine