title: Follow-up urine cultures and fever in children with urinary tract infection.
abstract: BACKGROUND
  The American Academy of Pediatrics practice parameter for urinary tract infection suggests a repeat urine culture if the expected clinical response is not achieved within the first 48 hours of therapy. The utility of repeat urine cultures and clinical significance of fever at 48 hours is unclear.
  
  
  OBJECTIVE
  To determine the frequency of positive repeat urine cultures in children admitted to the hospital with urinary tract infection, and to describe the fever curves of children admitted to the hospital with urinary tract infection.
  
  
  METHODS
  We reviewed all cases of urinary tract infection in children 18 years and younger who were admitted during a 5-year period to Children's Hospital of Wisconsin (Milwaukee). We recorded temperatures from hospital admission to discharge, age, sex, initial and follow-up culture results, antibiotics received, imaging performed, and medical history.
  
  
  RESULTS
  Urinary tract infection was identified in 364 patients, and 291 (79.9%) had follow-up urine cultures. None were positive. Follow-up cultures produced 21,388.50 US dollars in patient charges. Fever lasted beyond 48 hours in 32% of patients. Older children were more likely to have fever beyond 48 hours.
  
  
  CONCLUSIONS
  Follow-up urine cultures were of no utility in children hospitalized for urinary tract infection, including those with fever lasting beyond 48 hours or those with an underlying urologic disease. Fever beyond 48 hours is common and should not be used as a criterion for obtaining a repeat urine culture. These conclusions are valid for children with vesicoureteral reflux. Such an approach would result in significant cost savings.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Currie
authors.forename: Lindsay
authors.initials: L
authors.lastname: Mitz
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Raasch
authors.forename: Larry A
authors.initials: LA
authors.lastname: Greenbaum
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D019564:Unnecessary Procedures; D014552:Urinary Tract Infections / Q000652:urine*; D014556:Urine / Q000382:microbiology*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology