Urine testing and urinary tract infections in febrile infants seen in office settings: the Pediatric Research in Office Settings' Febrile Infant Study.
OBJECTIVE
To determine the predictors and results of urine testing of young febrile infants seen in office settings.


METHODS
Prospective cohort study.


METHODS
Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network.


METHODS
A total of 3066 infants 3 months or younger with temperatures of 38 degrees C or higher were evaluated and treated according to the judgment of their practitioners.


METHODS
Urine testing results, early and late urinary tract infections (UTIs), and UTIs with bacteremia.


RESULTS
Fifty-four percent of the infants initially had urine tested, of whom 10% had a UTI. The height of the fever was associated with urine testing and a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for both). Younger age, ill appearance, and lack of a fever source were associated with urine testing but not with a UTI, whereas lack of circumcision (adjusted odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration of fever (adjusted odds ratio, 1.8 for fever lasting > or = 24 hours) were not associated with urine testing but were associated with a UTI. Bacteremia accompanied the UTI in 10% of the patients, including 17% of those younger than 1 month. Among 807 infants not initially tested or treated with antibiotics, only 2 had a subsequent documented UTI; both did well.


CONCLUSIONS
Practitioners order urine tests selectively, focusing on younger and more ill-appearing infants and on those without an apparent fever source. Such selective urine testing, with close follow-up, was associated with few late UTIs in this large study. Urine testing should focus particularly on uncircumcised boys, girls, the youngest and sickest infants, and those with persistent fever.
Newman
Thomas B
TB
Department of Epidemiology and Biostatistics, University of California, San Francisco, Campus Box 0560, San Francisco, CA 94143-0560, USA. newman@epi.ucsf.edu
Bernzweig
Jane A
JA
Takayama
John I
JI
Finch
Stacia A
SA
Wasserman
Richard C
RC
Pantell
Robert H
RH
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002944:Circumcision, Male; D005260:Female; D005334:Fever / Q000382:microbiology*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D018579:Patient Selection; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016482:Urinalysis / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000652:urine*