title: Febrile young infants with altered urinalysis at low risk for invasive bacterial infection. a Spanish Pediatric Emergency Research Network's Study.
abstract: BACKGROUND
  Urinary tract infection (UTI) is the most common serious bacterial infection (SBI) in infants younger than 90 days of age. Many physicians admit infants younger than 90 days old because of their greater risk of developing invasive bacterial infections (IBIs), secondary to UTI. The primary objective of this study was to design a prediction model to identify febrile infants younger than 90 days old with an altered urinalysis who were at low risk for IBI and suitable for outpatient management
  
  
  METHODS
  : Prospective multicenter study included 19 hospitals that are members of the Spanish Pediatric Emergency Research Group of the Spanish Society of Pediatric Emergencies. Febrile infants younger than 90 days old with altered urinalysis were included.
  
  
  RESULTS
  A total of 766 (22.5%) infants with altered urine dipstick were analyzed. Fifty (6.5%) of them developed IBI, 39 (78.0%) secondary to UTI. Patients were at low risk for IBI if they were well appearing at arrival to the emergency department, were older than 21 days and had procalcitonin and C-reactive protein (CRP) blood values lower than 0.5 ng/mL and 20 mg/L, respectively. These factors were used to create a prediction model for IBI secondary to UTI, with a sensitivity of 100% (95% CI: 89.3-100) and a negative predictive value of 100% (95% CI: 97.5-100).
  
  
  CONCLUSIONS
  We have derived a highly accurate prediction model for IBI in febrile infants with altered urinalysis. Given these results, outpatient management might be suitable for 1 of each 4 infants diagnosed, with a considerable improvement in resource utilization.
authors.affiliation: From the *Pediatrics Department and †Intensive Care Unit, Rio Hortega University Hospital, Valladolid, Spain; and ‡Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Velasco
authors.forename: Helvia
authors.initials: H
authors.lastname: Benito
authors.forename: Rebeca
authors.initials: R
authors.lastname: Mozún
authors.forename: Juan E
authors.initials: JE
authors.lastname: Trujillo
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Merino
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
authors.forename: San
authors.initials: S
authors.lastname: Tiago
mesh_terms: D000553:Ambulatory Care; D001424:Bacterial Infections / Q000150:complications*; D003661:Decision Support Techniques; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology*; D013030:Spain; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000150:complications*